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Digestive Diseases and Sciences

, Volume 61, Issue 8, pp 2417–2425 | Cite as

Moderate Alcohol Use and Insulin Action in Chronic Hepatitis C Infection

  • Blaire E. Burman
  • Peter Bacchetti
  • Mandana Khalili
Original Article

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.

Keywords

Hepatitis C Insulin resistance Insulin secretion Metabolic syndrome Clamp testing 

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

Notes

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).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to report.

Supplementary material

10620_2016_4119_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Blaire E. Burman
    • 1
  • Peter Bacchetti
    • 2
  • Mandana Khalili
    • 1
    • 3
  1. 1.Department of Medicine, San Francisco General HospitalUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Liver CenterUniversity of California, San FranciscoSan FranciscoUSA

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