Estado nutricional, composição corporal e polimorfismo genético em pacientes com hepatite c crônica

Abstract

Several cofactors associated with the progression of hepatic disease often coincide with chronic hepatitis C (CHC). The interaction among the hepatitis C virus (HCV), host genetic factors, and environmental variables is significant and should not be overlooked. Therefore, we examined the prevalence of interleukin (IL) 6-174 G/C single nucleotide polymorphisms (SNPs), as well as IL10 −1082 A/G, −819C/T, and −592C/A SNP, in patients with CHC and healthy individuals of the same ethnicity. Additionally, we assessed the relationship between demographic, clinical, virological, nutritional, body composition, and genetic variables and the presence of cirrhosis. In this cross-sectional study, 147 patients were prospectively included. However, nine patients were excluded: five due to inadequate blood samples for genotyping and four because it was not possible to complete the body assessment using electrical bioimpedance. 138 patients with chronic hepatitis C remained [82 (59.4%) male; mean age 51.0 ± 11.8 years] and 70 blood donors [39 (55.7%) male; mean age 43.7 ± 8.6 years] who underwent clinical and nutritional evaluation. Liver cirrhosis was diagnosed through clinical evaluation and biochemical, histological and imaging methods tests. Regarding the components of body composition, skeletal muscle mass (SMM) and phase angle (PhA) were evaluated using bioelectrical impedance (BIA). The skeletal muscle mass index was calculated by dividing the SMM by the squared height. The SNPs of the genes encoding IL-6 and IL-10 were evaluated by Taqman SNP genotyping. The data were analyzed using the SPSS version 26.0 statistical program. Associations between liver cirrhosis and the following variables: demographic data (sex; age), stage of liver disease (patients without cirrhosis and patients with compensated liver cirrhosis), lifestyle [sedentary lifestyle (physical activity <600 MET-min per week) and active lifestyle (physical activity >600 MET - min per week), PhA (measured value), virological characteristics (HCV-RNA), SNPs of the genes encoding IL-6 and IL-10 were evaluated by univariate analysis. All variables with P values < 0.20 were included in the logistic regression models. The odds ratio and 95% confidence interval were used as a risk estimate. The Hosmer-Lemeshow test was used to evaluate the adequacy of the models. The significance level was set at P values ≤ 0.05. The polymorphisms of the genes encoding IL-6 and IL-10 were in Hardy-Weinberg equilibrium. Patients without cirrhosis (62.6%) were more likely to exhibit the GCC haplotype than those with compensated cirrhosis (44.7%), P = 0.04. A significantly higher frequency of low PhA was observed in male patients with compensated cirrhosis (32.3%) than in men without cirrhosis (11.8%), P = 0.03. In the multivariate analysis, it was demonstrated that the ATA haplotype [Odds ratio [OR] = 2.46; 95% confidence interval [CI] = 1.07 -5.65; P = 0.03), low PhA (OR = 3.08; 95%CI = 1.25 - 7.63; P = 0.02) and metabolic syndrome (OR = 3.33; 95%CI = 1.45 - 7.65; P = 0.005) were independently associated with cirrhosis. In summary, the ATA haplotype, which is associated with reduced IL-10 production, was associated with cirrhosis in patients chronically infected with HCV. Furthermore, low PhA, a nutritional marker indicative of cell membrane integrity, was correlated with the presence of cirrhosis in patients with chronic hepatitis C.