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

Background/aims: 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.

Methods: Obese patients (body mass index, BMI ≥30 kg/m(2) ) 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.

Results: Ten non-cirrhotic and six cirrhotic patients [age 52 ± 8.5 years, BMI 35.9 (31.46-38.21)kg/m(2) ] 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%), P < 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) (P = 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).

Conclusions: 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.