American Journal of Epidemiology Advance Access originally published online on May 11, 2007
American Journal of Epidemiology 2007 166(2):196-203; doi:10.1093/aje/kwm061
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Hepatitis C Virus Infection and the Development of Type 2 Diabetes in a Community-based Longitudinal Study
1 Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
2 A-Lein Community Health Center, Kaohsiung County, Taiwan
3 Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
4 Department of Radiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
5 Division of Gastroenterology, Department of Internal Medicine and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Correspondence to Dr. Pesus Chou, Institute of Public Health, National Yang-Ming University, Shih-Pai, Taipei 112, Taiwan (e-mail: pschou{at}ym.edu.tw).
Received for publication May 29, 2006. Accepted for publication January 22, 2007.
The temporal relation of hepatitis C virus (HCV) infection to the development of type 2 diabetes remains unknown. The authors followed 4,958 persons aged 
40 years without diabetes (3,486 seronegative, 812 anti-HCV+, 116 with hepatitis B virus/HCV coinfection, and 544 hepatitis B surface antigen (HBsAg)+) from a community-wide cohort in southern Taiwan for 7 years (1997–2003) to study the risk of diabetes associated with HCV infection. A total of 474 participants developed diabetes. The 7-year cumulative incidence was 7.5% for HBsAg+, 8.6% for seronegative, 14.3% for anti-HCV+, and 14.7% for coinfected participants. Compared with HCV– persons, HCV+ persons had a higher cumulative incidence of diabetes (log-rank test, p < 0.0001). A multivariate Cox proportional hazards model showed that anti-HCV+ (hazard ratio = 1.7, 95% confidence interval: 1.3, 2.1), coinfection (hazard ratio = 1.7), overweight, obesity, and increasing age were significantly associated with diabetes (p < 0.05). Gender, educational level, HBsAg+ status, alcohol consumption, and smoking were not significant. After stratification by age and body mass index, the risk ratio for diabetes in anti-HCV+ participants increased when age decreased and body mass index levels increased (p < 0.001). Results show that HCV infection is an independent predictor of diabetes, especially for anti-HCV+ persons who are younger or have a higher body mass index.
body mass index; cohort studies; diabetes mellitus; hepatitis C
Abbreviations: HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus
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  C.-S. Wang, S.-T. Wang, and P. Chou THREE AUTHORS REPLY Am. J. Epidemiol., March 15, 2008; 167(6): 751 - 752. [Full Text] [PDF]
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C. E. Behrendt RE: "HEPATITIS C VIRUS INFECTION AND THE DEVELOPMENT OF TYPE 2 DIABETES IN A COMMUNITY-BASED LONGITUDINAL STUDY" Am. J. Epidemiol., March 15, 2008; 167(6): 751 - 751. [Full Text] [PDF]
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