Impact of Ethnicity and Antioxidant Use on the Prevalence and Severity of Steatosis in Patients with Chronic Hepatitis C Virus Infection

Abstract

Purpose: Both ethnicity and antioxidant use may affect the prevalence of steatosis among patients with nonalcoholic steatohepatitis. Although steatosis is a common histologic finding in patients with chronic hepatitis C virus (HCV) infection, it is unclear if ethnicity or antioxidant use influence steatosis formation. The aim of the present study was to determine the impact of ethnicity and antioxidant use on the prevalence and severity of steatosis in patients with chronic HCV infection. Methods: Prior to liver biopsy, patients were interviewed by a research assistant who obtained detailed demographic and clinical data, as well as information on the use of antioxidants (vitamin C and E). Steatosis was scored according to the percent of hepatocytes involved as none (no steatosis), mild (<33%), moderate (33%–66%), or severe (>66%) using the Brunt system; fibrosis was scored on a scale from 0–4. Results: 577 were patients enrolled, including 185 non-Hispanic whites, 234 non-Hispanic blacks, 139 Hispanics, and 19 who self-reported their ethnicity as other. Among whites, blacks, Hispanics, and other ethnic groups, respectively, there were significant differences in the prevalence of steatosis of any grade (56.2% vs 43.6% vs 64.0% vs 47.4%, p = 0.001), moderate/severe steatosis (21.1% vs 14.5% vs 31.7% vs 21.1%, p = 0.001), and stage 3/4 fibrosis (31.4% vs 20.9% vs 42.4% vs 36.8%, p < 0.001). Antioxidant use was reported by 241 subjects (41.8%); 99 (17.2%) used vitamin C only, 62 (10.7%) used vitamin E only, and 80 (13.9%) were taking both vitamin C and E. Patients taking antioxidants had a lower prevalence of steatosis of any grade (42.3% vs 60.1%, p < 0.001), moderate/severe steatosis (15.8% vs 24.7%, p = 0.009), and stage 3/4 fibrosis (23.7% vs 34.5%, p = 0.005) compared with those who were not taking these supplements. Overall, the steatosis grade was strongly correlated with fibrosis stage (r =+0.56, p < 0.001) and this varied from +0.42 to +0.76 across ethnic groups (p < 0.01 for all groups). Ethnicity and antioxidant use remained independently associated with both steatosis and fibrosis after adjusting for age, gender, alcohol use, diabetes, BMI, triglycerides, and HCV genotype. Conclusions: There were marked ethnic differences in the prevalence and severity of steatosis and fibrosis among patients with chronic HCV infection, with the prevalence being highest in Hispanics and lowest in blacks. In this population, antioxidant use was associated with a significantly lower prevalence and severity of steatosis and fibrosis. Randomized controlled trials to evaluate the beneficial effect of antioxidants are warranted in patients with HCV infection.