Industrial, not fruit fructose intake is associated with the severity of liver fibrosis in genotype 1 chronic hepatitis C patients

Background & Aims: Unhealthy food intake, specifically fructose, has been associated with metabolic alterations and with the severity of liver fibrosis in patients with non-alcoholic fatty liver disease. In a cohort of patients with genotype 1 chronic hepatitis C (G1 CHC), we tested the association of fructose intake with the severity of liver histology. Methods: Anthropometric and metabolic factors, including waist circumference (WC), waist-to-hip ratio (WHR), dorso-cervical lipohypertrophy and HOMA were assessed in 147 consecutive biopsy-proven G1 CHC patients. Food intake, namely industrial and fruit fructose, was investigated by a three-day structured interview and a computed database. All biopsies were scored by an experienced pathologist for staging and grading (Scheuer classification), and graded for steatosis, which was considered moderate-severe if >= 20%. Features of non-alcoholic steatohepatitis (NASH) in CHC were also assessed (Bedossa classification). Results: Mean daily intake of total, industrial and fruit fructose was 18.0 +/- 8.7 g, 6.0 +/- 4.7 g, and 11.9 +/- 7.2 g, respectively. Intake of industrial, not fruit fructose, was independently associated with higher WHR (p = 0.02) and hypercaloric diet (p <0.001). CHC patients with severe liver fibrosis (>= F3) reported a significantly higher intake of total (20.8 +/- 10.2 vs. 17.2 +/- 8.1 g/day; p = 0.04) and industrial fructose (7.8 +/- 6.0 vs. 5.5 +/- 4.2; p = 0.01), not fruit fructose (12.9 +/- 8.0 vs. 11.6 +/- 7.0; p = 0.34). Multivariate logistic regression analysis showed that older age (OR 1.048, 95% CI 1.004-1.094, p = 0.03), severe necroinflammatory activity (OR 3.325, 95% CI 1.347-8.209, p = 0.009), moderate-severe steatosis (OR 2.421, 95% CI 1.017-6.415, p = 0.04), and industrial fructose intake (OR 1.147, 95% CI 1.047-1.257, p = 0.003) were independently linked to severe fibrosis. No association was found between fructose intake and liver necroinflammatory activity, steatosis, and the features of NASH. Conclusions: The daily intake of industrial, not fruit fructose is a risk factor for metabolic alterations and the severity of liver fibrosis in patients with G1 CHC. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.