Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 14, 2012; 18(18): 2203-2211
Published online May 14, 2012. doi: 10.3748/wjg.v18.i18.2203
Effect of soy protein supplementation in patients with chronic hepatitis C: A randomized clinical trial
Lucivalda PM Oliveira, Rosangela P de Jesus, Ramona SSB Boulhosa, Carlos Mauricio C Mendes, Maria Cecilia Gnoatto, Denise C Lemaire, Maria Betania P Toralles, Lourianne N Cavalcante, Andre C Lyra, Luiz GC Lyra
Lucivalda PM Oliveira, Postgraduate Course in Medicine and Health and Nutrition Science Department, Federal University of Bahia, Bahia 40110-150, Brazil
Rosangela P de Jesus, Nutrition Science Department, Federal University of Bahia, Bahia 40110-150, Brazil
Ramona SSB Boulhosa, Lourianne N Cavalcante, Postgraduate Course in Medicine and Health, Federal University of Bahia, Bahia 40110-150, Brazil
Carlos Mauricio C Mendes, the Medicine and Health Postgraduation program, Federal University of Bahia, Bahia 40110-150, Brazil
Maria Cecilia Gnoatto, the Radiology Service, Prof. Edgard Santos University Hospital, Federal University of Bahia, Bahia 40110-150, Brazil
Denise C Lemaire, Laboratory of Immunology, Health Science Institute, Federal University of Bahia, Bahia 40110-150, Brazil
Maria Betania P Toralles, Pediatric Department, Federal University of Bahia, Bahia 40110-150, Brazil
Andre C Lyra, Department of Medicine, Division of Gastroenterology and Hepatology, Federal University of Bahia and Gastro-hepatology Unit, Hospital São Rafael of Bahia, Bahia 40110-150, Brazil
Luiz GC Lyra, the Medicine and Health Postgraduation program, Federal University of Bahia and Gastro-hepatology Unit, Hospital São Rafael of Bahia, Bahia 40110-150, Brazil
Author contributions: Oliveira LPM, Jesus RP, Lyra AC, Lemaire DC and Lyra LGC designed the research; Oliveira LPM, Jesus RP, Boulhosa RSSB, Cavalcante LNC and Lyra AC evaluated and assisted the patients; Oliveira LPM, Jesus RP, Boulhosa RSSB, Gnoatto MC and Toralles MBP conducted the research; Oliveira LPM and Mendes CMC analyzed the data and performed statistical analysis; Oliveira LPM, Jesus RP, Lyra AC and Lyra LGC wrote the paper.
Supported by Gold Nutrition Indústria e Comercio and Centro colaborador Nordeste II/Ministério da Saúde, Brazil
Correspondence to: Lucivalda PM de Oliveira, Professor, School of Nutrition/Nutritional Science Department, Federal University of Bahia, Araújo Pinho Avenue, 32-Canela, Salvador, Bahia 40110-150, Brazil. valdapm@hotmail.com
Telephone: +55-71-32837726 Fax: +55-71- 32837705
Received: June 1, 2011
Revised: September 9, 2011
Accepted: March 28, 2012
Published online: May 14, 2012
Abstract

AIM: To evaluate the effects of soy supplementation on insulin resistance, fatty liver and alanine aminotransferase (ALT) levels in non-diabetic patients with chronic hepatitis C (CHC).

METHODS: In a prospective, randomized and single-blinded clinical trial, we compared patients with CHC who had casein as a supplement (n = 80) (control group), with patients who consumed a soy supplement diet (n = 80) [intervention group (IG)]. Both groups received 32 g/d of protein for 12 wk.

RESULTS: Patients’ baseline features showed that 48.1% were overweight, 43.7% had abdominal fat accumulation, 34.7% had hepatic steatosis and 36.3% had an homeostasis model assessment index of insulin resistance (HOMA-IR) ≥ 3.0. Descriptive analysis showed that protein supplementation diet reduced hepatic steatosis in both groups; however, significant reductions in ALT levels occurred in the soy group. Multiple regression modeling indicated that in the presence of severe fibrosis (F3/F4), γ glutamyl transferase elevation and high density lipoprotein (HDL) reduction, the intervention group had 75% less chance of developing hepatic steatosis (OR= 0.25; 95% CI: 0.06-0.82) and 55% less chance of presenting with an ALT level ≥ 1.5 × the upper limit of normal (ULN) (OR = 0.45, 95% CI: 0.22-0.89). Soy treatment did not have any effect on insulin resistance (OR = 1.92; 95% CI: 0.80-4.83), which might be attributed to the fact that the HOMA-IR values at baseline in most of our patients were in the normal range. Advanced hepatic fibrosis, an ALT level > 1.5 × ULN and visceral fat were predictors of an HOMA-IR ≥ 3. The IG group had a reduced risk of an ALT level > 1.5 × ULN. An HOMA-IR ≥ 3.0 and HDL < 35 mg/dL were also risk factors for increased ALT.

CONCLUSION: Soy supplementation decreased ALT levels and thus may improve liver inflammation in hepatitis C virus (HCV) patients; it also reduced hepatic steatosis in a subgroup of patients but did not change insulin resistance. It should be considered in the nutritional care of HCV patients.

Keywords: Chronic hepatitis C; Soy supplementation; Insulin resistance; Hepatic steatosis; Hepatitis C virus