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Fw: NATAP: Treatment Strategies for Fatty Liver

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  • Alley Pat
    NATAP http://natap.org/ ... Metabolics/Belly Fat Advance HCV Disease - (05/30/06) Impact of obesity on treatment of chronic hepatitis C Hepatology June 2006,
    Message 1 of 1 , Jul 28, 2006
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      NATAP http://natap.org/


      Metabolics/Belly Fat Advance HCV Disease - (05/30/06)

      "Impact of obesity on treatment of chronic hepatitis C"

      Hepatology June 2006, Vol 43, Issue 6, pages 1177- 1186

      ".....Current understanding of obesity is that it constitutes a metabolic condition and is not simply a function of having high body weight. .....clinical factors associated with the metabolic syndrome - including elevated waist- to- hip ratio, the presence of insulin resistance, and diabetes - have been shown to predict more advanced forms of chronic hepatitis C.... Several studies have demonstrated that SVR rates are lower in patients with coexistent insulin resistance and/or hepatic steatosis/steatohepatitis.... HCV RNA levels have been found to correlate with degree of steatosis, viral eradication results in regression of steatosis, and steatosis returns with relapse....TREATMENT STRATEGIES: .......the most direct approach is to encourage weight loss and exercise before treatment..... Recently reported data suggest that treatment with the insulin- sensitizing medications metformin and the thiazolidinediones (pioglitazone and rosiglitazone) reduced serum ALT and histologic features of hepatic steatosis, inflammation, and fibrosis, as well as increased insulin sensitivity, in nondiabetic patients with nonalcoholic steatohepatitis....... Other approaches to enhance response to combination treatment with peginterferon alpha plus ribavirin include longer duration of treatment and, possibly, higher flat doses, which may counteract the decreased bioavailability of drug and increased resistance to interferon- based therapies. Longer treatment, especially in patients infected with HCV genotype 1, may enhance SVR rates. In addition, higher doses of peginterferon may enhance SVR rates in obese individuals. Rather than being based strictly on weight, higher peginterferon doses could be based on a threshold BMI (e.g., 30 kg/m2) or a threshold value for visceral fat or insulin resistance, as measured HOMA- IR index....."

      Authors: Michael R. Charlton 1 *, Paul J. Pockros 2, Stephen A. Harrison 3 1Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 2Division of Gastroenterology/Hepatology, Scripps Clinic, La Jolla, CA 3Division of Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, TX


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