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Hepatitis, Diabetes and Lipodystrophy

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  • claudine intexas
    Subject: NATAP: Hepatitis, Diabetes, and Lipodystrophy NATAP www.natap.org ... Hepatitis, Diabetes and Lipodystrophy In this report from yesterday researchers
    Message 1 of 1 , Dec 28, 2000
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      Subject: NATAP: Hepatitis, Diabetes, and Lipodystrophy

      NATAP
      www.natap.org
      ----------------

      Hepatitis, Diabetes and Lipodystrophy

      In this report from yesterday researchers suggest
      liver disease
      contributes
      to diabetes developing. After thius first report is a
      write-up I did of
      a
      report at the Conference for the European Association
      of the Study of
      the
      Liver held in Amsterdam in the Spring 2000. It
      suggests that liver
      disease
      plays a role in the development of reduced bone
      mineral density and
      diabetes.
      I hypothesize that liver damage may play a role in the
      development of
      lipodystrophy, whether it be elevated lipids
      (cholesterol,
      triglyverides,
      etc) or body changes.

      "Hepatitis C Infection Increases Diabetes Risk"
      Reuters Health Information Services
      (www.reutershealth.com)
      (10/16/00)
      A new study from Johns Hopkins University shows
      that people
      age 40 or over who are infected with hepatitis C virus
      (HCV) have
      over three times the risk of type 2 diabetes. Shruti
      Mehta and
      colleagues evaluated over 9,800 adults, 2 percent of
      whom had HCV
      infection. According to their report in the Annals of
      Internal
      Medicine (2000;133:592-599), the rate of type 2
      diabetes was
      higher in the HCV group compared to those
      HCV-negative, for
      subjects over 40. The findings support the idea that
      HCV
      infection can cause type 2 diabetes through
      progressive liver
      damage.

      Here is my report from EASL-

      CHRONIC LIVER DISEASE: DIABETES and BONE MASS (EASL
      abstracts)

      What are the responsible factors of the development of
      diabetes
      mellitus in
      chronic liver disease?

      Although an increased prevalence of diabetes mellitus
      (DM) in chronic
      liver
      disease is known for many years, the responsible
      factors for the
      development
      of DM are inconclusive. The aim of this retrospective
      study is to
      identify
      the facilitating factors (age, sex, etiology of liver
      disease duration
      of
      liver disease, biochemical findings, stage of chronic
      hepatitis,
      Child's
      class) resulting in DM in 659 chronic hepatitis
      patients and 689
      cirrhotic
      patients by using uni- and multivariate analysis. The
      age-matched
      materials
      of 23,679 cases of a previous study about the
      frequency of DM in
      community
      was accepted as a control group [Diabetes 1998;
      47(suppl 1):A384].
      Chronic
      hepatitis patients were constituted of 5 subgroups
      (306 HBV, 269 HCV,
      37
      autoimmune, 33 HDV, 14 HBV+HCV), and cihhotic patients
      8
      subgroups (208 HBV, 144 HCV, 94 cryptogenic, 77
      cholestatic, 70 HDV, 63
      alcohol, 27 autoimmune, 6 HBV+HCV).

      The prevalence of DM was 3.7% in controls, 5.8% in
      chronic hepatitis
      (p<0.01), and 12.7% in liver cirrhosis (p<0.001,
      p<0.001,
      respectively).
      Although the rate of DM was not significantly
      different among chronic
      hepatitis subgroups, 12.9% of patients in stage II and
      3.1% of stage I
      (p<0.01). In liver cirrhosis, the prevalence of DM
      was significantly
      higher
      (p<0.05-0.001) in HCV-related cirrhosis (25.6%) than
      in all other
      subgroups
      except the HBV+HCV related cirrhosis. DM was more
      frequently occurred
      in
      Child's C than in both Child's A and B (p<0.05).
      Multi-variate analysis
      showed that age (p<0.001) and HCV in liver cirrhosis,
      and age (p<0.001)
      in
      chronic hepatitis were independent predictors for DM.
      As a result, DM
      more
      commonly develops in chronic liver disease than in
      community. The risk
      of DM
      increases with the progression of liver disease and
      the advance of age.
      In
      cirrhotic patients, it seems that chronic HCV
      infection is an
      additional risk
      factor for DM.

      Bone Mass and Chronic Viral Hepatitis

      M Auletta, V Nuzzo, F Fonderico, MR Fittipaldi, S
      Antonielli, G Lupoli

      Dept of Clinical Medicine and Cardiovascular Sciences,
      and Dept of
      Molecular
      and Clinical Endocrinology and Oncology, Federico II
      University,
      Naples.
      Italy

      The liver plays a central role in bone metabolism.
      Several studies
      reported
      low bone mineral density (BMD) in chronic liver
      disease especially
      cholestatic, alcoholic, corticosteroid-treated chronic
      hepatitis,
      hemochromatosis. The aim of this
      study was to examine the prevalence of osteoporosis
      and/or osteopenia
      in a
      consecutive series of patients affected by chronic
      viral hepatitis.
      Twenty-five male patients, aged 41-59 years, affected
      by biopsy-proven
      chronic hepatitis
      correlated to C virus were studied. Exclusion criteria
      were: body mass
      index
      (BMI) <20 and >25 Kg/m2, hyperbilirubinemia, advanced
      liver cirrhosis,
      cholestatic and alcoholic liver disease, previous
      therapy or disease
      affecting bone mass. BMD was evaluated by dual energy
      X-ray
      absorptiometry
      (DEXA) at lumbar spine (L1-L4) and
      femural neck (FN) using a hologic QDR 1000
      densitometer.

      The results are expressed as BMD (g/cm2), T score (SD
      from the mean
      value
      obtained I 30 year old subjects) and Z score (SD from
      mean valu
      obtained in
      subjects of the same age & sex). Serum calcium,
      phosphorous, ALP,
      gonadotropins, testosterone, thyroid hormones,
      cortisol, PTH, urinary
      calcium, and hydroxyproline were evaluated. A complete
      clinical,
      biochemical
      and ultrasonographic evaluation of liver disease was
      performed.

      The results showed an alteration of bone mass in 16
      out of 25 patients
      (64%):
      in fact, T score resulted <-1 SD in 11 (44%), and <2.5
      SD in 5 patients
      (20%). Moreover an inverse correlation (p<0.05) was
      found only among
      BMD at
      lumbar spine, serum calcium and duration of liver
      disease. At femoral
      neck a
      direct correlation between BMD and BMI (p<0.05) and an
      inverse one
      between
      BMD and cortisol (p<0.05) were found. No correlation
      was found with
      patient's
      age. The reduction of BMD in patients with
      non-advanced viral liver
      disease
      suggests that more attention should be paid to BMD in
      patients without
      cholestasis, alcoholic consumption, malnutrition,
      and/or factors
      affecting
      bone metabolism.


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