Diabetes Linked to Greater Liver Damage With Hepatitis C

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Diabetes Linked to Greater Liver Damage With Hepatitis C

Among people with untreated hepatitis C — a chronic viral infection that can severely damage the liver — having diabetes was linked to more extensive liver damage, according to a new study published in the journal JAMA Network Open.

Even outside the context of hepatitis C, diabetes is linked to liver changes that can lead to long-term damage to the organ — a condition known as nonalcoholic fatty liver disease (NAFLD) that often goes unrecognized. As the name suggests, NAFLD is characterized by abnormally high levels of liver fat. While having unusually high levels of liver fat typically doesn’t cause any immediate symptoms, these changes to the structure of the liver can eventually lead to a form of damage called fibrosis. As fibrosis develops, your liver function can start to deteriorate, and fibrosis can also lead to an even more severe form of damage called cirrhosis. Some estimates suggest that at least half of all people with diabetes will develop NAFLD at some point — which is very bad news, since the condition is linked to several worse health outcomes, including a higher risk of dying with advanced NAFLD. Having NAFLD is also linked to a higher risk for severe hypoglycemia (low blood glucose) in people with type 2 diabetes.

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For the latest study, researchers at Emory University in Atlanta examined test results and other health outcomes in 960 people with untreated hepatitis C, with an average age of 58. Out of these participants, 632 (66%) were men, 761 (79%) were Black, 247 (26%) had obesity, and 231 (24%) had diabetes. When it came to having liver fibrosis assessed, 501 participants (52%) had a score of F0 to F1 (no damage to mild damage), 212 (22%) had a score of F2 (moderate damage), 80 (8%) had a score of F3 (severe damage), and 167 (17%) had a score of F4 (advanced damage, or cirrhosis).

Separately, the researchers looked at the extent of fatty liver disease, known as steatosis. Overall, 622 participants (65%) had a score of S0 (none), 117 (12%) had a score of S1 (mild), 111 (12%) had a score of S2 (moderate), and 110 (11%) had a score of S3 (severe). The rate of steatosis was 6% for participants without obesity or diabetes, 22% for participants with obesity but without diabetes, and 34% for participants with both obesity and diabetes.

Diabetes linked to higher risk of liver disease, damage

The researchers found that after controlling for a number of factors — including age, sex, race, and obesity — having diabetes was linked to a 44% higher risk for steatosis, and a 76% higher risk for fibrosis. Alcohol use was also independently linked to a 40% higher risk for steatosis, and a 43% higher risk for fibrosis. Obesity was linked to a 36% higher risk for fibrosis, and a 378% higher risk for steatosis. The researchers found no significant interactions between diabetes and alcohol use when it came to the risk for either steatosis or fibrosis — in other words, drinking alcohol increased these risks by about the same amount in participants with diabetes as it did in those without diabetes.

“Our findings suggest an urgent need to investigate the interaction of multiple risk factors and the progression of liver disease” in people with hepatitis C, the researchers concluded — especially since certain kinds of liver damage can lead to liver cancer, and some people may need to be screened for liver cancer earlier than others.

Want to learn more about protecting your liver? Read “Diabetes and NAFLD” and “Preventing Fatty Liver (NAFLD).”

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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