Impact of obesity and omega-3 polyunsaturated fatty acids on fibrogenesis and responsiveness to antiviral therapy in chronic hepatitis C.

Chronic Hepatitis C (CHC) and obesity inflict significant health and economic burdens on the world. A complex interplay between these conditions results in the ultimate phenotype of liver disease. Taking into consideration the increasing prevalence of obesity in patients with CHC and the decreasing rate of sustained virologic response (SVR), it would be advantageous to identify potential therapeutic strategy to improve liver histology and responsiveness to antiviral therapy. The adipokines-leptin, adiponectin, TNF-alpha-, which are modified in obesity, have been proposed as determinant factors of non-responsiveness to the IFN-alpha/Ribavirin treatment and of liver fibrosis extension in patients with CHC and obesity. Weight loss and long-term maintenance of optimal weight resulted in a sustained improvement in hepatic fibrosis and an increased rate of SVR in obese patients with CHC. The ability to exert antiviral activities and the anti-obesity effect of omega-3 PUFA provide a good basis for clinical use of these very interesting nutrients, both as dietary components and as future drugs with potentially beneficial effects and few side effects. We reviewed the mechanisms underlying the correlation of obesity with the nonresponsiveness to antiviral therapy and with fibrosis extension in CHC, and the mechanisms by which PUFA omega-3 may be associated with an increased efficacy of interferon-based therapies and an antifibrogenic effect in obese individuals with CHC.