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Moderate Alcohol Use and Insulin Action in Chronic Hepatitis C Infection

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Abstract

Background and Aim

Chronic hepatitis C (HCV) is associated with metabolic abnormalities including insulin resistance (IR) and diabetes. While moderate alcohol consumption is known to have beneficial metabolic effects in the general population, such potential effects in HCV are unknown. We aimed to assess the association between graded alcohol intake and IR, insulin secretion, and metabolic syndrome in HCV.

Methods

Ninety-five non-diabetic HCV-infected patients underwent detailed metabolic testing. IR was directly measured via steady-state plasma glucose (SSPG) during a 240-min insulin suppression test. Total insulin secretion and insulinogenic index were determined by 75-g oral glucose tolerance test. Genotyping of CYP2E1 was performed to detect genetic polymorphisms influencing alcohol metabolism.

Results

In this cohort, 61 % were abstinent from alcohol for the past 12 months, while 22 % were moderate, and 17 % heavy drinkers. Obesity and nonwhite ethnicity were the strongest predictors of IR. Moderate alcohol intake (vs none) was significantly associated with lower SSPG only among those with normal BMI (coef −72.9, 95 % CI −128.1 to −17.6, p = 0.01). Alcohol use was not associated with insulin secretion parameters when controlling for IR and other factors. Heavy alcohol intake (OR 3.2, 95 % CI 0.86–12.3) and nonwhite ethnicity (OR 7.1, 95 % CI 1.5–33.3) were associated with metabolic syndrome. Among nonwhites, the odds of metabolic syndrome were fivefold higher for heavy drinkers.

Conclusions

Moderate alcohol intake is associated with improved insulin sensitivity in HCV, although this benefit was limited to normal-weight individuals. The potential benefit of moderate alcohol on IR and its metabolic consequences in HCV warrants further longitudinal investigation.

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Abbreviations

HCV:

Hepatitis C virus

IR:

Insulin resistance

HBV:

Hepatitis B virus

HIV:

Human immunodeficiency virus

NIAAA:

National Institute on Alcohol Abuse and Alcoholism

OGTT:

Oral glucose tolerance test

IST:

Insulin suppression test

SSPG:

Steady-state plasma glucose

I-AUC:

Area under the curve of insulin

G-AUC:

Area under the curve of glucose

BMI:

Body mass index

ALT:

Alanine aminotransferase

HDL:

High-density lipoprotein

ADH:

Alcohol dehydrogenase

ALDH:

Aldehyde dehydrogenase

HOMA:

Homeostatic model assessment

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Financial support

This work was in part supported by Hepatology Training Grant DK060414 (B.E.B.), R01 DK074673 (M.K.), K24AA022523 (M.K.), P30 DK026743 (UCSF Liver Center), and UL1 TR000004 (NIH/NCATS UCSF-CTSI).

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Authors and Affiliations

  1. Department of Medicine, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, NH-3D, San Francisco, CA, 94110, USA

    Blaire E. Burman & Mandana Khalili

  2. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Peter Bacchetti

  3. Liver Center, University of California, San Francisco, San Francisco, CA, USA

    Mandana Khalili

Authors
  1. Blaire E. Burman
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  2. Peter Bacchetti
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  3. Mandana Khalili
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Correspondence to Mandana Khalili.

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Burman, B.E., Bacchetti, P. & Khalili, M. Moderate Alcohol Use and Insulin Action in Chronic Hepatitis C Infection. Dig Dis Sci 61, 2417–2425 (2016). https://doi.org/10.1007/s10620-016-4119-0

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