Sex difference in liver-related mortality and transplantation associated with dietary cholesterol in chronic hepatitis C virus infection

Br J Nutr. 2016 Jan 28;115(2):193-201. doi: 10.1017/S0007114515004158. Epub 2015 Nov 6.


Dietary cholesterol induces hepatic inflammation and fibrosis in animals. We aimed to determine whether dietary cholesterol affects liver-related mortality in hepatitis C virus (HCV)-infected patients. We performed a retrospective cohort study using extended follow-up data from the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis Trial. The study included HCV patients with advanced fibrosis and compensated cirrhosis. The analysis included 657 patients who completed two FFQ. We assessed whether cholesterol intake, measured in mg/4184 kJ (mg/1000 kcal) of energy intake, was associated with liver-related death or transplantation. In 4·7 (sd 1·6) years, the incidence of liver-related death (n 46) or transplantation (n 52) was 31·8/1000 person-years. The relationship between cholesterol intake and liver-related death or transplantation was significantly different between men and women (test for interaction, P value=0·01). Each higher quartile of cholesterol intake was associated with an increased risk for liver-related death or transplantation in women (adjusted hazard ratio (AHR) 1·83; 95 % CI 1·12, 2·99; P trend=0·02), but not in men (AHR 0·96; 95 % CI 0·76, 1·22; P trend=0·73). Compared with women whose cholesterol intake was within the recommended guidelines (300 mg/d with a 8368 kJ (2000 kcal) diet), women who consumed more cholesterol had significantly increased risk for liver-related death or transplantation (AHR 4·04; 95 % CI 1·42, 11·5). High dietary cholesterol was associated with an increased risk for liver-related death and transplantation in HCV-infected women with advanced fibrosis or compensated cirrhosis. Future studies should assess whether reducing cholesterol intake, among women who consume an excessive amount, can decrease HCV-related mortality.

Keywords: AHR adjusted hazard ratio; Cholesterol; Cirrhosis; Diets; HALT-C Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis; HCC hepatocellular carcinoma; HCV hepatitis C virus; Hepatitis C virus; MTP microsomal triglyceride transfer protein; Sex differences.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Antiviral Agents / therapeutic use
  • Cholesterol, Dietary / adverse effects*
  • Cohort Studies
  • Energy Intake
  • Female
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / mortality*
  • Hepatitis C, Chronic / surgery
  • Humans
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / surgery
  • Liver Cirrhosis / virology
  • Liver Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Sex Factors*


  • Antiviral Agents
  • Cholesterol, Dietary