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A 24-week dietary and physical activity lifestyle intervention reduces hepatic insulin resistance in the obese with chronic hepatitis C



Jenny Heathcote, Toronto Western Hospital, 399 Bathurst St. 6B Fell Rm 154, Toronto, M5T 2S8 ON, Canada

Tel: +1 416 603 5800 x 2350

Fax: +1 416 603 6281




Obesity- and virus-mediated insulin resistance (IR) are associated with adverse hepatic and metabolic outcomes in chronic hepatitis C (CHC). This study evaluates the tolerability and effects of a dietary and physical activity (PA) intervention in obese patients with insulin-resistant CHC.


Obese patients (body mass index, BMI ≥30 kg/m2) with CHC were recruited prospectively. Non-diabetic patients with IR (homeostasis model assessment of IR, HOMA-IR >2.0) proceeded to a 24-week lifestyle intervention comprising pedometer monitored increase in PA (≥10 000 steps/day) and an individualised dietary plan.


Ten non-cirrhotic and six cirrhotic patients [age 52 ± 8.5 years, BMI 35.9 (31.46–38.21)kg/m2] were recruited, of whom all 16 (100%) completed the 24-week protocol. Increase in PA from 6853 (2440–9533) to 10 697 (7959–13566) steps/day (P = 0.001) and reduction in caloric intake from 2263 (1805.4–2697.0) to 1281 (1099.5–1856.3) kcal/day (equivalent to reduction of median 33% (25.3–49.8%), < 0.001) were achieved. These behaviour changes led to a BMI reduction to 31.21 (28.72–36.10) (P < 0.001) and the HOMA-IR fell from 3.62 (2.75–4.87) to 2.08 (1.82–3.59) (= 0.002). The hepatic insulin sensitivity index (ISI) improved significantly, but the skeletal muscle ISI did not. At week 24, 8/16 (50%) patients were no longer insulin-resistant (P = 0.008).


This 24-week intervention reduced BMI and reversed IR in significant proportion of patients. Such adjunctive therapy may improve hepatic and metabolic status in obese insulin-resistant CHC.