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 30kg/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 (10000 steps/day) and an individualised dietary plan. Results Ten non-cirrhotic and six cirrhotic patients [age 52 +/- 8.5years, BMI 35.9 (31.4638.21)kg/m2] were recruited, of whom all 16 (100%) completed the 24-week protocol. Increase in PA from 6853 (24409533) to 10697 (795913566) steps/day (P=0.001) and reduction in caloric intake from 2263 (1805.42697.0) to 1281 (1099.51856.3) kcal/day (equivalent to reduction of median 33% (25.349.8%), P<0.001) were achieved. These behaviour changes led to a BMI reduction to 31.21 (28.7236.10) (P<0.001) and the HOMA-IR fell from 3.62 (2.754.87) to 2.08 (1.823.59) (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.