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lüll Importance of hepatitis C virus-associated insulin resistance: therapeutic strategies for insulin sensitization Kawaguchi T; Sata MWorld J Gastroenterol 2010[Apr]; 16 (16): 1943-52Insulin resistance is one of the pathological features in patients with hepatitis C virus (HCV) infection. Generally, persistence of insulin resistance leads to an increase in the risk of life-threatening complications such as cardiovascular diseases. However, these complications are not major causes of death in patients with HCV-associated insulin resistance. Indeed, insulin resistance plays a crucial role in the development of various complications and events associated with HCV infection. Mounting evidence indicates that HCV-associated insulin resistance may cause (1) hepatic steatosis; (2) resistance to anti-viral treatment; (3) hepatic fibrosis and esophageal varices; (4) hepatocarcinogenesis and proliferation of hepatocellular carcinoma; and (5) extrahepatic manifestations. Thus, HCV-associated insulin resistance is a therapeutic target at any stage of HCV infection. Although the risk of insulin resistance in HCV-infected patients has been documented, therapeutic guidelines for preventing the distinctive complications of HCV-associated insulin resistance have not yet been established. In addition, mechanisms for the development of HCV-associated insulin resistance differ from lifestyle-associated insulin resistance. In order to ameliorate HCV-associated insulin resistance and its complications, the efficacy of the following interventions is discussed: a late evening snack, coffee consumption, dietary iron restriction, phlebotomy, and zinc supplements. Little is known regarding the effect of anti-diabetic agents on HCV infection, however, a possible association between use of exogenous insulin or a sulfonylurea agent and the development of HCC has recently been reported. On the other hand, insulin-sensitizing agents are reported to improve sustained virologic response rates. In this review, we summarize distinctive complications of, and therapeutic strategies for, HCV-associated insulin resistance. Furthermore, we discuss supplementation with branched-chain amino acids as a unique insulin-sensitizing strategy for patients with HCV-associated insulin resistance.|*Insulin Resistance[MESH]|Antiviral Agents/pharmacology[MESH]|Carcinoma, Hepatocellular/complications/virology[MESH]|Cell Proliferation[MESH]|Esophageal and Gastric Varices/virology[MESH]|Fatty Liver/pathology[MESH]|Fibrosis/virology[MESH]|Hepacivirus/*metabolism[MESH]|Hepatitis C/*complications/immunology/*virology[MESH]|Humans[MESH]|Insulin/*metabolism/therapeutic use[MESH]|Life Style[MESH]|Liver Neoplasms/complications/virology[MESH]|Liver/pathology[MESH] |