Association of Lipids With HCV Seropositivity and Diabetes
Association of Lipids With HCV Seropositivity and Diabetes
Background and Aims: Hepatitis C virus (HCV) infection is reported to be associated with or to cause type 2 diabetes mellitus (T2DM). Our study aimed to elucidate the role of triglyceride (TG) and cholesterol (CHOL) levels in the association between anti-HCV seropositivity and T2DM in an HCV-endemic area.
Methods: We analyzed a computerized dataset of 56 338 residents from a community-based comprehensive screening program in Tainan County in southern Taiwan. Fasting glucose, anti-HCV status, hepatitis B surface antigen (HBsAg) status, platelet counts, TG levels, CHOL levels, age, gender, and body mass index were included in the analyses. Multivariate logistic analysis was used to identify factors independently associated with T2DM.
Results: Older age, being overweight, thrombocytopenia, hypertriglyceridemia, hypercholesterolemia, anti-HCV seropositivity, and HBsAg seronegativity were common factors independently associated with diabetes. Among all models of multiple logistic regression analysis used for identifying factors independently associated with T2DM, anti-HCV seropositivity was only identified in the models that included either hypertriglyceridemia or hypercholesterolemia. When subjects were divided into hyperlipidemia (CHOL, > 200 or TG, > 150 mg/dL; n = 33 393) or non-hyperlipidemia subgroups (CHOL, < 200 and TG, < 150 mg/dL; n = 22 945), anti-HCV seropositivity was identified as an independent factor only in the non-hyperlipidemia subgroup. The odds ratio was 1.35, with a 95% confidence interval of 1.17–1.55.
Conclusions: This study demonstrates that the lipid level is associated with the relationship between T2DM and anti-HCV seropositivity in non-hyperlipidemic individuals. However, the relationship between HCV and T2DM did not exist when the lipid level was not included in the analysis.
Type 2 diabetes mellitus (T2DM) and chronic hepatitis C virus (HCV) infection are two major public health issues. According to epidemiological studies, the prevalence of HCV infection is 1–3% in Western countries and 4.4% in Taiwan. However, rates are higher in some areas of southern Taiwan, reaching approximately 10–90%. Statistical data from the World Health Organization (WHO) indicate that diabetes affected more than 346 million people and killed 3.4 million people because of a high blood sugar level in 2004. In Taiwan, T2DM was the fifth leading cause of death in 2010.
In addition to causing liver injury, HCV infection has also been shown to reduce the expression of extrahepatic factors such as serum triglyceride (TG) and cholesterol (CHOL) levels. HCV infection is associated with some immunological disorders and different phenotypes in diabetic cases. It is also related to the development of endocrine diseases.
Recently, the association between HCV infection and T2DM has received much attention. However, most of the studies that have demonstrated this link have been cross-sectional studies from hospital-based settings in subjects with severe liver disease, which could have caused glucose intolerance and insulin resistance. However, two community-based investigations from southern Taiwan have also revealed a link between HCV and T2DM. Almost all of these studies showed a significant relationship between HCV and T2DM, but the odds ratio (OR) was less than 2. Additionally, some studies have revealed that HCV infection is associated with insulin resistance but not with metabolic syndrome.
Given the complicated association between HCV infection, T2DM, and lipid levels, we conducted this large-scale community-based study to elucidate the association between seropositivity for hepatitis C virus and T2DM in adult residents of a hepatitis C-endemic area. Furthermore, we aimed to clarify the role of TG and CHOL levels in the association between anti-HCV seropositivity and T2DM.
Abstract and Introduction
Abstract
Background and Aims: Hepatitis C virus (HCV) infection is reported to be associated with or to cause type 2 diabetes mellitus (T2DM). Our study aimed to elucidate the role of triglyceride (TG) and cholesterol (CHOL) levels in the association between anti-HCV seropositivity and T2DM in an HCV-endemic area.
Methods: We analyzed a computerized dataset of 56 338 residents from a community-based comprehensive screening program in Tainan County in southern Taiwan. Fasting glucose, anti-HCV status, hepatitis B surface antigen (HBsAg) status, platelet counts, TG levels, CHOL levels, age, gender, and body mass index were included in the analyses. Multivariate logistic analysis was used to identify factors independently associated with T2DM.
Results: Older age, being overweight, thrombocytopenia, hypertriglyceridemia, hypercholesterolemia, anti-HCV seropositivity, and HBsAg seronegativity were common factors independently associated with diabetes. Among all models of multiple logistic regression analysis used for identifying factors independently associated with T2DM, anti-HCV seropositivity was only identified in the models that included either hypertriglyceridemia or hypercholesterolemia. When subjects were divided into hyperlipidemia (CHOL, > 200 or TG, > 150 mg/dL; n = 33 393) or non-hyperlipidemia subgroups (CHOL, < 200 and TG, < 150 mg/dL; n = 22 945), anti-HCV seropositivity was identified as an independent factor only in the non-hyperlipidemia subgroup. The odds ratio was 1.35, with a 95% confidence interval of 1.17–1.55.
Conclusions: This study demonstrates that the lipid level is associated with the relationship between T2DM and anti-HCV seropositivity in non-hyperlipidemic individuals. However, the relationship between HCV and T2DM did not exist when the lipid level was not included in the analysis.
Introduction
Type 2 diabetes mellitus (T2DM) and chronic hepatitis C virus (HCV) infection are two major public health issues. According to epidemiological studies, the prevalence of HCV infection is 1–3% in Western countries and 4.4% in Taiwan. However, rates are higher in some areas of southern Taiwan, reaching approximately 10–90%. Statistical data from the World Health Organization (WHO) indicate that diabetes affected more than 346 million people and killed 3.4 million people because of a high blood sugar level in 2004. In Taiwan, T2DM was the fifth leading cause of death in 2010.
In addition to causing liver injury, HCV infection has also been shown to reduce the expression of extrahepatic factors such as serum triglyceride (TG) and cholesterol (CHOL) levels. HCV infection is associated with some immunological disorders and different phenotypes in diabetic cases. It is also related to the development of endocrine diseases.
Recently, the association between HCV infection and T2DM has received much attention. However, most of the studies that have demonstrated this link have been cross-sectional studies from hospital-based settings in subjects with severe liver disease, which could have caused glucose intolerance and insulin resistance. However, two community-based investigations from southern Taiwan have also revealed a link between HCV and T2DM. Almost all of these studies showed a significant relationship between HCV and T2DM, but the odds ratio (OR) was less than 2. Additionally, some studies have revealed that HCV infection is associated with insulin resistance but not with metabolic syndrome.
Given the complicated association between HCV infection, T2DM, and lipid levels, we conducted this large-scale community-based study to elucidate the association between seropositivity for hepatitis C virus and T2DM in adult residents of a hepatitis C-endemic area. Furthermore, we aimed to clarify the role of TG and CHOL levels in the association between anti-HCV seropositivity and T2DM.