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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2010;9 Supl 1:S119-22" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 63 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 24 "PDF" => 27 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Hepatitis C and hepatocellular carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S119" "paginaFinal" => "S122" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eduardo Fassio" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Fassio" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119317363?idApp=UINPBA00004N" "url" => "/16652681/00000009000000S1/v1_201906221034/S1665268119317363/v1_201906221034/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S166526811931734X" "issn" => "16652681" "doi" => "10.1016/S1665-2681(19)31734-X" "estado" => "S300" "fechaPublicacion" => "2010-01-01" "aid" => "71396" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2010;9 Supl 1:S107-11" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 63 "formatos" => array:3 [ "EPUB" => 21 "HTML" => 19 "PDF" => 23 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Acute hepatitis C treatment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S107" "paginaFinal" => "S111" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Figure 1.</span></span>" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 495 "Ancho" => 1019 "Tamanyo" => 60493 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Outcome of HCV infection.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paulo Roberto Lerias de Almeida" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Paulo Roberto" "apellidos" => "Lerias de Almeida" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S166526811931734X?idApp=UINPBA00004N" "url" => "/16652681/00000009000000S1/v1_201906221034/S166526811931734X/v1_201906221034/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "titulo" => "Insulin resistance, hepatic steatosis and hepatitis C: A complex relationship with relevant clinical implications" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S112" "paginaFinal" => "S118" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marco Arrese, Arnoldo Riquelme, Alejandro Soza" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Marco" "apellidos" => "Arrese" "email" => array:1 [ 0 => "marrese@med.puc.cl" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Arnoldo" "apellidos" => "Riquelme" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Soza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile." "etiqueta" => "*" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Figure 1:</span></span>" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 911 "Ancho" => 1000 "Tamanyo" => 104275 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Relationships between metabolic and viral factors and hepatic steatosis in the setting of chronic hepatitis C. Insulin resistance is the major determinant of steatosis and in turn is aggravated by several genotype-independent mechanisms probably related to the presence of viral proteins in the hepatocyte and due to the inflammatory response linked to viral infection. Several specific steatogenic mechanisms operate in genotype 3 infection. Alcohol consumption can also contribute to steatosis development.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="p0050" class="elsevierStylePara elsevierViewall">Insulin resistance (IR) is a complex pathophysiological condition where higher-than-normal concentrations of insulin are needed to maintain a normal glycemia and adequate glucose utilization in insulin target tissues.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> IR is of global importance since is closely linked to an epidemic condition such as obesity and it precedes and predicts the development of type 2 diabetes mellitus (T2DM). IR is also considered the main underlying cause of the so-called metabolic syndrome, a cluster of metabolic abnormalities that are associated to increased cardiovascular risk.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the field of liver diseases, IR has reached significant notoriety as it promotes hepatic steatosis and for being considered the major underlying defect of non-alcoholic fatty liver disease (NAFLD), the most common liver disease in the West.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="p0055" class="elsevierStylePara elsevierViewall">IR is frequently found in patients with chronic hepatitis C (CHC).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Estimations from different sources indicate that roughly 50% of patients with CHC exhibit some evidence of insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This association is more frequent than that expected or predicted by chance and may have impact in the natural history of the disease as well as on treatment outcomes.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In addition, recent research had disclosed the existence of a complex relationship between the hepatitis C virus (HCV) infection and insulin resistance where viral-induced and host’s metabolic abnormalities seem to act in a mutually reinforcing manner.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This review summarizes recent information on the intricacies and links between hepatitis C viral infection and IR. For a more detailed review of the topic the reader is referred to recent in-depth and state-of-the art papers.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Epidemiological Aspects</span><p id="p0060" class="elsevierStylePara elsevierViewall">As mentioned before, the association of IR and CHC occurs more often than predicted by chance with figures ranging between 30 to 70%.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This was first noted in 2003 by Hui, <span class="elsevierStyleItalic">et al.</span>,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> that compared values of fasting C peptide, serum insulin and homeos-tatic model assessment (HOMA-IR) in HCV infected patients and healthy volunteers showing that patients with HCV infection exhibit significantly higher levels of C peptide, fasting serum insulin and HOMA-IR compared with matched controls. High frequency of IR in HCV-infected patients has been confirmed by several studies with some differences related to the way that IR is assessed.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> HOMA-IR is the most commonly used tool which has a reasonable but not perfect correlation with the gold standard tool which is the 2-step hyperinsulinemic-euglycemic clamp.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="p0065" class="elsevierStylePara elsevierViewall">IR is also likely responsible of the increased prevalence and incidence of T2DM in patients with CHC.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The reported prevalence of T2DM in non-cirrhotic patients with CHC is between 7 to 21% which is higher than that observed in other forms of chronic hepatitis or in the general population. Moreover, a prospective study showed that patients with HCV infection and a high-risk profile for developing T2DM developed the disease 11 times more frequently than those without HCV infection.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In line with these findings, a meta-analysis of 34 studies performed by White et al. and concluded that a significant DM risk in HCV-infected cases exists in comparison to non-infected controls in both retrospective and prospective studies.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="p0070" class="elsevierStylePara elsevierViewall">Since IR is closely linked to hepatic steatosis is also of interest to analyze the frequency of this finding in patients with HCV infection. Of note, the prevalence of hepatic steatosis is also significantly increased in HCV-infected patients compared with patients with other hepatopathies reaching figures nearer to 50% and ranging from 40% to 80%.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Even though hepatic steatosis is a very prevalent condition in the general population, this figure is higher than that expected by chance.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Interestingly, a consistent finding among published studies is that steatosis has a close relationship with viral genotype. Infection with genotype 3 HCV is more strongly related to steatosis than infection by non-3 genotypes, exhibiting figures of prevalence of steatosis of 70-80%,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Moreover, in genotype 3 HCV-infected patients steatosis correlates with viral load.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This suggests that, in the case of this genotype, viral-specific mechanisms promotes fat deposition in the liver cell.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> On the other hand, a weaker correlation with viral load and higher values of IR parameters such as HOMA-IR index indicates that, in the setting of infection with non-3 genotypes of HCV, occurrence of steatosis is more closely linked to basal metabolic abnormalities and IR. The latter may indeed be aggravated by viral infection.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Thus, current evidence suggests that while HCV-associated hepatic steatosis is mainly virus-induced in genotype-3 infected patients, host-factors (mainly IR) play a major role in steatosis in non-3 genotypes.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Pathogenetic Considerations</span><p id="p0075" class="elsevierStylePara elsevierViewall">The relationship between IR and HCV infection is complex and bidirectional (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>). On one side IR, through promotion of steatosis, hepatic inflammation and a pro-fibrogenic state, might increase the chance of aggravating disease activity or determine disease progression. On the other, HCV infection itself may, through several mechanisms, induce a worsening of the insulin resistant state, promoting T2DM and hepatic derangements linked to lipotoxicity thus increasing liver injury. A brief summary of the potential mechanisms at play in this setting is provided below.</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">IR and HCV</span><p id="p0080" class="elsevierStylePara elsevierViewall">IR is a complex condition which exact cause is not yet clear. It involves a disturbed action in insulin-sensitive organs such as the liver, muscle and adipose tissue.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Insulin effects are elicited after binding of insulin to its receptor that is linked to a complex signaling pathway that involves sequential activation of the insulin receptor substrates (IRS), phosphatidyli-nositol-3-kinase (PI3K), Akt and protein kinase C.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This cascade of events has been well characterized at the molecular level and essentially results in promotion of cellular storage of excess glucose as glycogen, suppression of gluconeogenesis and, in muscle and adipose tissue, stimulation of glucose uptake after translocation of the glucose transporter GLUT4 to the plasma membrane. IR results from defects at any level of the insulin receptor-related signaling pathway. Details of these defects are beyond the scope of this review and can be found elsewhere.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It is of interest however, to point out that HCV infection seems to be able of either directly induce or worsening a pre-existent IR. Compelling evidence of the latter comes from experiments involving transgenic mice showing direct effects of HCV core protein in modulating insulin signaling.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> This effect is probably related to disturbed insulin signaling due changes in expression or activity of IRS-1.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Several other viral-related mechanisms such as increased HCV-core induction of the molecule suppressor of cytokine signaling 3 (SOCS-3), leading to proteasomal degradation of IRS-1 and IRS-2 have been described <span class="elsevierStyleItalic">in vitro</span><a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> but its importance in the clinical setting are unknown.</p><p id="p0085" class="elsevierStylePara elsevierViewall">Other important aspect of the relation between IR and HCV infection is the role of hepatic and systemic inflammation. It has been suggested that increased levels of pro-inflammatory cytokines such as interleu-kin (IL)-1, tumor necrosis factor (TNF-α), IL-6 and leptin, and reduced levels of adiponectin may directly contribute to the occurrence of HCV-related IR.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Although there is <span class="elsevierStyleItalic">in vitro</span> evidence in support of this view (i.e. TNF-α interferes with insulin signaling in the liver by inducing serine phosphorylation of IRS-1 and hypophosphorylation of IRS-2), a direct proof of this has been difficult in the clinical setting due to the presence of many confounders.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Steatosis and HCV</span><p id="p0090" class="elsevierStylePara elsevierViewall">fat accumulation in the liver cell (steatosis) can occur by many mechanisms. The commonest causes are linked to alcohol consumption and metabolic de-rangements, mainly IR, seen in overweight and obese people with IR and/or diabetes. The latter condition (which is termed NAFLD) encompasses a pathological spectrum from simple steatosis to an inflammatory form of the disease termed nonalcoholic steatohepatitis (NASH). While simple steatosis has a benign clinical course NASH patients are deemed at high-risk for developing more advanced fi-brosis, cirrhosis and hepatocellular carcinoma.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="p0095" class="elsevierStylePara elsevierViewall">NAFLD pathogenesis may involve a two-step process. The first and obligatory phase, is the development of IR that has a central role in triglyceride accumulation in liver cells.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In the setting of IR, uninhibited lipolysis occurs in adipose tissue determining a fatty acid overflow to the liver. After their uptake by hepatocytes, fatty acids are utilized for triglyceride synthesis.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> In addition, compensatory hyperinsulinemia present in IR contributes to stimulate <span class="elsevierStyleItalic">de novo</span> lipogenesis in the liver cell contributing to steatosis. The second step, which occurs only in a proportion of NAFLD subjects, is hepatic inflammation and triggering of local fibrogenesis. The underlying mechanisms that determine that some individuals with simple steatosis evolve toward NASH remain unknown. However, inflammatory events occurring in the adipose tissue are key initial events in promotion IR through adipokine imbalance and fatty acid-induced oxidative stress are considered among the main culprits.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="p0100" class="elsevierStylePara elsevierViewall">Being both common entities in the general population, NAFLD and HCV infection can clearly coexist. Since HCV infection may aggravate IR, which is the main cause of NAFLD, it is difficult to quanti-tate the contribution of each condition in a given patient. Some authors have proposed that NAFLD or NASH can be diagnosed on histological basis in the setting of concomitant HCV infection.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> However, this is controversial and difficult due to lack of information on cut-offs for the degree of steatosis and the fact that some histological findings can be present in both conditions. In spite of that, it has been estimated that 10% of patients with HCV display features of NASH.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> As mentioned before, the close association of steatosis with HCV genotype 3 infection suggests that direct viral-related steatoge-nic mechanisms are at play in this setting. In the case of non-3 genotypes, pre-existing IR drives stea-tosis development and worsening of IR due to HCV infection can either increase the degree of steatosis or determine progression to NASH. Some of the proposed specific mechanisms involved in the pathoge-nesis of steatosis in the context of HCV infection are shown in <a class="elsevierStyleCrossRef" href="#t0005">table 1</a>.</p><elsevierMultimedia ident="t0005"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical Implications</span><p id="p0105" class="elsevierStylePara elsevierViewall">The clinical implications of the presence of IR and steatosis in patients with CHC have become evident in many studies that consistently showed that these co-factors are related to both a poorer response to antiviral therapy and disease progression.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Current data on the topic is summarized below.</p><p id="p0110" class="elsevierStylePara elsevierViewall">The negative impact of IR on achieving sustained viral response (SVR, defined as undetectable HCV RNA 24 weeks after completing treatment) after standard antiviral therapy (Pegylated interferon plus ribavirin) in patients with CHC has been demonstrated in several studies. Romero-Gómez, <span class="elsevierStyleItalic">et al.</span>, <a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> showed marked differences in the rates of SVR in HCV infected patients with and without IR, assessed by HOMA-IR. In this study, 23 of 70 (32.8%) patients with genotype 1 CHC and IR (HOMA-IR > 2) achieved a SVR vs. 26 of 43 (60.5%) genotype 1 CHC patients without IR. These results has been confirmed by other authors (34-37) and extended to non-1 genotypes.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Thus, since IR is an independent predictor of treatment response, HOMA-IR could help to predict treatment outcome in a given patient.</p><p id="p0115" class="elsevierStylePara elsevierViewall">IR has been also associated to fibrosis in CHC pa-tients.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> However, it is its main consequence stea-tosis, the feature that has been found more consistently associated to disease progression in patients with CHC.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Studies including paired biopsies provide stronger evidence in this regard.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> More recently, these results were confirmed by analysis of data from the HALT-C Trial cohort.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> In this study involving more than 1000 patients, hepatic stea-tosis was a strong and independent predictor of fibrosis not related to other laboratory markers for liver disease severity. A number of mechanisms can account for the profibrogenic effects of IR and steatosis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="p0120" class="elsevierStylePara elsevierViewall">Another important clinical implication of IR in CHC is the strong relationship of IR and T2DM development.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Cross-sectional and longitudinal stu-dies support the notion that HCV infection determines an excess in the risk of developing T2DM, particularly in those with known risk fac-tors.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> More recently the relationships between HCV infection, T2DM and hepatocellular carcinoma have gained significant attention given the rise of liver cancer in the United States.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> Interestingly, it has been shown that IR is somewhat modified by treatment and that the incidence of T2DM in patients achieving SVR is significantly lower than that seen in non-responders.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Perpectives for Clinical Management</span><p id="p0125" class="elsevierStylePara elsevierViewall">Available data on the complex relationship between IR and CHC offers some opportunities for clinical intervention. This includes active management of body weight and specific pharmacological treatment of IR and/or hepatic steatosis.</p><p id="p0130" class="elsevierStylePara elsevierViewall">Although it has been shown that weight reduction may have impact on both liver histology and biochemistry in patients with CHC,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> interventions aiming to modify body weight before treatment have not been formally tested in large-scale trials. Thus, we do not known if patients that lose weight and introduce lifestyle changes have a different natural history that those that do not follow these general recommendations. However, analysis of outcomes in the HALT-C trial provides strong evidence about the benefits of weight loss in overweight or obese patients with CHC.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> In this study, patients that lost more than 5% of the baseline weight showed significant decrease in both hepatic steatosis and inflammation. As for the potential impact of weight loss on the response to antiviral treatment, no large prospective studies have been conducted. Only a small study reported by Tarantino, <span class="elsevierStyleItalic">et al.</span>,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> showed that a strict low calorie diet for three months, aiming to achieve a 10% reduction in body mass index before starting treatment, indeed determined higher rates of response to peginterferon plus riba-virin therapy. It is therefore appropriate to specifically counsel those CHC patients who are overweight or obese aiming to lose at least 5% of their basal weight in order to potentially improve the response to antiviral therapy.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> Joint work of hepatologists with a multidisciplinary obesity management-team could increase chances of a successful response in this setting.</p><p id="p0135" class="elsevierStylePara elsevierViewall">Management of IR with insulin sensitizing agents aiming to increase the chances of responding to treatment is another recently explored possibility.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However, available data is limited in this regard. The INSPIRED-HCV study<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> considered administration of pioglitazone to HCV infected patients that did not respond to standard treatment. This trial was prematurely terminated due to lack of efficacy. However, the dose of pioglitazone (15mg/d) and the difficult-to-treat patients included in the trial limit the interpretation of results. Other attempts of improving treatment response with pioglitazone have been reported. One study published only in abstract form showed that in genotype-1 patients naive to treatment 30 mg/d of pioglitazone showed a significantly increased occurrence of a rapid virological response.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> Unfortunately, SVR were not reported. In other preliminary study, Conjeevaram et al. showed that although pioglitazone treatment led to a significant reduction in IR and reversal of hepatic steatosis in HCV genotype-1 patients with IR, SVR was similar in treated and non-treated patients.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> Another recent study from Egypt involving HCV infected genotype 4 patients showed positive results.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> More recently, an interesting case-report suggest that sequential, rather than concomitant, administration of pioglitazone with antiviral therapy could be more effective in achieving response to treat-ment.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a> Finally, the addition of metformin to standard antiviral treatment was studied in a prospective, multicentered, randomized, double-blinded, placebo-controlled trial in 19 Spanish hospi-tals.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> Although there was a trend to achieve a higher SVR in metformin treated patients the study failed to show a statistically significant difference between arms. Clearly, additional studies on the role of adding insulin sensitizing agents to standard antiviral treatment are warranted.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Acknowledgement</span><p id="p0140" class="elsevierStylePara elsevierViewall">This work was partially supported by grants from the Fondo Nacional De Ciencia y Tecnología de Chile (Fondecyt #1080170 to MA and #1080323 to A.S.).</p><p id="p0145" class="elsevierStylePara elsevierViewall">This article is based in a oral presentation in a meeting of the Latinamerican Association for the Study of the Liver (ALEH), held in Cancún, México on March 18-19, 2009.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Abbreviations: Used in This Paper:</span><p id="p0150" class="elsevierStylePara elsevierViewall">IR: Insulin resistance; HCV: hepatitis C virus; T2DM: type 2 diabetes mellitus; NAFLD: non-alcoholic fatty liver disease; CHC; chronic hepatitis C; HOMA-IR: homeostatic model assessment; IRS: insulin receptor substrates; IL: interleukin; TNF: tumor necrosis factor; NASH: Nonalcoholic steatohepatitis; SVR: sustained viral response.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1210325" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abs0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1126742" "titulo" => "Key words" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiological Aspects" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Pathogenetic Considerations" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "IR and HCV" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Steatosis and HCV" ] ] ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Implications" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Perpectives for Clinical Management" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Acknowledgement" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Abbreviations: Used in This Paper:" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-03-20" "fechaAceptado" => "2010-04-20" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec1126742" "palabras" => array:4 [ 0 => "Fatty liver" 1 => "Insulin" 2 => "Diabetes" 3 => "Metabolic syndrome" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abs0005" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Insulin resistance (IR) is a common pathophysiological condition where higher-than-normal concentrations of insulin are needed to maintain a normal glycemia and adequate glucose utilization in insulin target tissues. A high proportion (50-80%) of patients chronically infected with the hepatitis C virus (HCV) exhibit evidence of IR. Basic and clinical studies have disclosed a complex bidirectional relationship between IR and HCV infection that has important clinical implications. HCV infection may promote IR through direct viral-dependent mechanisms or due to activation of the inflammatory response resulting in increased production of Tumor Necrosis Factor-α and other cytokine-related molecules. These abnormalities may act synergistically with pre-existing metabolic risk factors and result in the development of hepatic steatosis and type 2 diabetes mellitus (T2DM) which are frequently found in the setting of HCV infection. Moreover, in addition to underlying metabolic abnormalities leading to its development hepatic steatosis also exhibit genotype-specific pathogenic mechanisms. A number of studies have shown that hepatic steatosis is associated to fibrosis progression in patients with HCV and that IR has a negative impact on the response rates to interferon-a-based therapy. Thus, modification of these factors through life-style changes or pharmacological agents may represent an undervalued specific target of therapy aiming to improve sustained virolo-gical response rates and reduce HCV related-morbidity and mortality.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npara0005">Viral-related mechanisms are mainly at play in HCV gentotype-3 infection. HCV: Hepatitis C virus. VLDL: very low density lipoprotein. PPAR: peroxisome proliferator-activated receptor. SREBP: Sterol regulatory element binding protein. TNF: tumor necrosis factor. IRS-1: insulin receptor substrate-1.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "f0005" "etiqueta" => "<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Figure 1:</span></span>" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 911 "Ancho" => 1000 "Tamanyo" => 104275 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Relationships between metabolic and viral factors and hepatic steatosis in the setting of chronic hepatitis C. Insulin resistance is the major determinant of steatosis and in turn is aggravated by several genotype-independent mechanisms probably related to the presence of viral proteins in the hepatocyte and due to the inflammatory response linked to viral infection. Several specific steatogenic mechanisms operate in genotype 3 infection. Alcohol consumption can also contribute to steatosis development.</p>" ] ] 1 => array:7 [ "identificador" => "t0005" "etiqueta" => "<span class="elsevierStyleBold">Table 1.</span>" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="sp0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleFootnote" id="fn0005"><span class="elsevierStyleLabel">*</span><p class="elsevierStyleNotepara" id="npara0005">Viral-related mechanisms are mainly at play in HCV gentotype-3 infection. HCV: Hepatitis C virus. VLDL: very low density lipoprotein. PPAR: peroxisome proliferator-activated receptor. SREBP: Sterol regulatory element binding protein. TNF: tumor necrosis factor. IRS-1: insulin receptor substrate-1.</p></span></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle"><ul class="elsevierStyleList" id="li0005"><li class="elsevierStyleListItem" id="list0005"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">1.</span></span><p id="p0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Direct viral-related mechanisms.</span><ul class="elsevierStyleList" id="li0010"><li class="elsevierStyleListItem" id="list0010"><span class="elsevierStyleLabel">•</span><p id="p0010" class="elsevierStylePara elsevierViewall">HCV core protein inhibition of microsomal triglyceride transfer protein activity resulting in decreased VLDL secretion and intracellular accumulation of lipids.</p></li><li class="elsevierStyleListItem" id="list0015"><span class="elsevierStyleLabel">•</span><p id="p0015" class="elsevierStylePara elsevierViewall">Impaired expression and transcriptional activity of PPAR-a resulting in reduced mitochondrial oxidation of fatty acids.</p></li><li class="elsevierStyleListItem" id="list0020"><span class="elsevierStyleLabel">•</span><p id="p0020" class="elsevierStylePara elsevierViewall">Induction of SREBP-1 expression and transcriptional activity promoting hepatic lipogenesis.</p></li><li class="elsevierStyleListItem" id="list0025"><span class="elsevierStyleLabel">•</span><p id="p0025" class="elsevierStylePara elsevierViewall">Down-regulation of PPAR-γ mRNA.</p></li></ul></p></li><li class="elsevierStyleListItem" id="list0030"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">2.</span></span><p id="p0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Exacerbation of Insulin Resistance.</span><ul class="elsevierStyleList" id="li0015"><li class="elsevierStyleListItem" id="list0035"><span class="elsevierStyleLabel">•</span><p id="p0035" class="elsevierStylePara elsevierViewall">Increased levels of pro-inflammatory cytokines (i.e.TNF-α).</p></li><li class="elsevierStyleListItem" id="list0040"><span class="elsevierStyleLabel">•</span><p id="p0040" class="elsevierStylePara elsevierViewall">Viral Interference of the IRS-1 pathway.</p></li><li class="elsevierStyleListItem" id="list0045"><span class="elsevierStyleLabel">•</span><p id="p0045" class="elsevierStylePara elsevierViewall">Viral-induced oxidative stress.</p></li></ul></p></li></ul> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2066276.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Potential mechanisms involved in the development of hepatic steatosis in the setting of HCV infection.<a class="elsevierStyleCrossRef" href="#fn0005">*</a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:58 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance concepts." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Bloomgarden ZT" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc07-zb05" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "1320" "paginaFinal" => "1326" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17468377" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The insulin resistance syndrome: Definition and dietary approaches to treatment." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Reaven GM" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1146/annurev.nutr.24.012003.132155" "Revista" => array:6 [ "tituloSerie" => "Annu Rev Nutr" "fecha" => "2005" "volumen" => "25" "paginaInicial" => "391" "paginaFinal" => "406" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16011472" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current concepts in the pathogenesis of nonalcoholic fatty liver disease." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Méndez-Sánchez N" 1 => "Arrese M" 2 => "Zamora-Valdés D" 3 => "Uribe M" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1478-3231.2007.01483.x" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "423" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17403181" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatobiliary diseases and insulin resistance." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Méndez-Sánchez N" 1 => "Chávez-Tapia NC" 2 => "Zamora-Valdés D" 3 => "Medina-Santillan R" 4 => "Uribe M" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Curr Med Chem" "fecha" => "2007" "volumen" => "14" "paginaInicial" => "1988" "paginaFinal" => "1999" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17691941" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1529943013001745" "estado" => "S300" "issn" => "15299430" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance and steatosis in chronic hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Machado MV" 1 => "Cortez-Pinto H" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2009" "volumen" => "8" "paginaInicial" => "S67" "paginaFinal" => "S75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19381127" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance among patients with chronic hepatitis C: Etiology and impact on treatment." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Harrison SA" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2008.03.024" "Revista" => array:6 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2008" "volumen" => "6" "paginaInicial" => "864" "paginaFinal" => "876" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18585970" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance and hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Romero-Gómez M" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v12.i44.7075" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2006" "volumen" => "12" "paginaInicial" => "7075" "paginaFinal" => "7080" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17131467" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Steatosis and insulin resistance in hepatitis C: a way out for the virus?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Del Campo JA" 1 => "Romero-Gómez M" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.15.5014" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "5014" "paginaFinal" => "5019" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19859993" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular mechanisms of insulin resistance in chronic hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Douglas MW" 1 => "George J" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.15.4356" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "4356" "paginaFinal" => "4364" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19764085" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C, insulin resistance and diabetes: clinical and pathogenic data." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Serfaty L" 1 => "Capeau J" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1478-3231.2008.01952.x" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "13" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19187069" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C and hepatic steatosis." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Patel JH" 1 => "Cobbold JF" 2 => "Thomas HC" 3 => "Taylor-Robinson SD" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/qjmed/hcp192" "Revista" => array:7 [ "tituloSerie" => "QJM" "fecha" => "2010" "volumen" => "103" "numero" => "5" "paginaInicial" => "293" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20139103" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression [corrected]." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Hui JM" 1 => "Sud A" 2 => "Farrell GC" 3 => "Bandara P" 4 => "Byth K" 5 => "Kench JG" 6 => "McCaughan GW" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2003" "volumen" => "125" "paginaInicial" => "1695" "paginaFinal" => "1704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14724822" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance in chronic hepatitis C: Mechanisms and clinical relevance." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Bernsmeier C" 1 => "Heim MH" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "smw-12765" "Revista" => array:6 [ "tituloSerie" => "Swiss Med Wkly" "fecha" => "2009" "volumen" => "139" "paginaInicial" => "678" "paginaFinal" => "684" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20047129" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic hepatitis C is associated with peripheral rather than hepatic insulin resistance." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Milner KL" 1 => "Van der Poorten D" 2 => "Trenell M" 3 => "Jenkins AB" 4 => "Xu A" 5 => "Smythe G" 6 => "Dore GJ" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2010" "volumen" => "138" "numero" => "3" "paginaInicial" => "931" "paginaFinal" => "941" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C virus and type 2 diabetes." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Negro F" 1 => "Alaei M" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.15.1537" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "1537" "paginaFinal" => "1547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19340895" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C virus infection and incident type 2 diabetes." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Mehta SH" 1 => "Brancati FL" 2 => "Strathdee SA" 3 => "Pankow JS" 4 => "Netski D" 5 => "Coresh J" 6 => "Szklo M" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2003.50291" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2003" "volumen" => "38" "paginaInicial" => "50" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12829986" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C infection and risk of diabetes: A systematic review and meta-analysis." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "White DL" 1 => "Ratziu V" 2 => "El-Serag HB" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2008.08.006" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2008" "volumen" => "49" "paginaInicial" => "831" "paginaFinal" => "844" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18814931" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review article: Non-alcoholic fatty liver disease and hepatitis C virus-partners in crime." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Blonsky JJ" 1 => "Harrison SA" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2008.03672.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "855" "paginaFinal" => "865" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18315584" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of obesity, steatosis and insulin resistance on progression and response to therapy of hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Negro F" 1 => "Clement S" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2893.2009.01186.x" "Revista" => array:6 [ "tituloSerie" => "J Viral Hepat" "fecha" => "2009" "volumen" => "16" "paginaInicial" => "681" "paginaFinal" => "688" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19732324" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The insulin resistance syndrome: Concept and therapeutic approaches." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Reaven GM" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "MogensenCE" "titulo" => "Pharma-cotherapy of diabetes: New developments. improving life and prognosis for diabetic patients." "paginaInicial" => "19" "paginaFinal" => "30" "serieFecha" => "2007" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of disease: molecular and metabolic mechanisms of insulin resistance and beta-cell failure in type 2 diabetes." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Muoio DM" 1 => "Newgard CB" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrm2327" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Mol Cell Biol" "fecha" => "2008" "volumen" => "9" "paginaInicial" => "193" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18200017" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C virus infection and diabetes: direct involvement of the virus in the development of insulin resistance." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Shintani Y" 1 => "Fujie H" 2 => "Miyoshi H" 3 => "Tsutsumi T" 4 => "Tsukamoto K" 5 => "Kimura S" 6 => "Moriya K" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2004" "volumen" => "126" "paginaInicial" => "840" "paginaFinal" => "848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14988838" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance and liver injury in hepatitis C is not associated with virus-specific changes in adipocytokines." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Cua IH" 1 => "Hui JM" 2 => "Bandara P" 3 => "Kench JG" 4 => "Farrell GC" 5 => "McCaughan GW" 6 => "George J" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21703" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "66" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17596870" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Matteoni CA" 1 => "Younossi ZM" 2 => "Gramlich T" 3 => "Boparai N" 4 => "Liu YC" 5 => "McCullough AJ" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1999" "volumen" => "116" "paginaInicial" => "1413" "paginaFinal" => "1419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10348825" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Bugianesi E" 1 => "Leone N" 2 => "Vanni E" 3 => "Marchesini G" 4 => "Brunello F" 5 => "Carucci P" 6 => "Musso A" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2002" "volumen" => "123" "paginaInicial" => "134" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12105842" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of insulin resistance in nonalcoholic fatty liver disease." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Utzschneider KM" 1 => "Kahn SE" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2006-0587" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2006" "volumen" => "91" "paginaInicial" => "4753" "paginaFinal" => "4761" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16968800" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatty liver and lipotoxicity." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Trauner M" 1 => "Arrese M" 2 => "Wagner M" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbalip.2009.10.007" "Revista" => array:7 [ "tituloSerie" => "Biochim Biophys Acta" "fecha" => "2010" "volumen" => "1801" "numero" => "3" "paginaInicial" => "299" "paginaFinal" => "310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19857603" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuclear receptors, inflammation and liver disease: Insights for cholestatic and fatty liver diseases." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Arrese M" 1 => "Karpen SJ" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/clpt.2010.2" "Revista" => array:7 [ "tituloSerie" => "Clin Pharmacol Ther" "fecha" => "2010" "volumen" => "87" "numero" => "4" "paginaInicial" => "473" "paginaFinal" => "478" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20200515" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C and nonalcoholic fatty liver disease." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Ramesh S" 1 => "Sanyal AJ" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2004-860869" "Revista" => array:6 [ "tituloSerie" => "Semin Liver Dis" "fecha" => "2004" "volumen" => "24" "paginaInicial" => "399" "paginaFinal" => "413" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15605308" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of treatment with peginterferon or interferon alfa-2b and ribavirin on steatosis in patients infected with hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Poynard T" 1 => "Ratziu V" 2 => "McHutchison J" 3 => "Manns M" 4 => "Goodman Z" 5 => "Zeuzem S" 6 => "Younossi Z" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2003.50267" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2003" "volumen" => "38" "paginaInicial" => "75" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12829989" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C and insulin resistance: steatosis, fibrosis and non-response." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Romero-Gómez M" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2006" "volumen" => "98" "paginaInicial" => "605" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17048997" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of steatosis on progression of fibrosis in patients with mild hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Fartoux L" 1 => "Chazouilleres O" 2 => "Wendum D" 3 => "Poupon R" 4 => "Serfaty L" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20519" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "82" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15690484" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Romero-Gómez M" 1 => "Del Mar VM" 2 => "Andrade RJ" 3 => "Salmerón J" 4 => "Diago M" 5 => "Fernández-Rodríguez CM" 6 => "Corpas R" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2005" "volumen" => "128" "paginaInicial" => "636" "paginaFinal" => "641" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15765399" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance is a major determinant of sustained virological response in genotype 1 chronic hepatitis C patients receiving peginterferon alpha-2b plus ribavirin." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Chu CJ" 1 => "Lee SD" 2 => "Hung TH" 3 => "Lin HC" 4 => "Hwang SJ" 5 => "Lee FY" 6 => "Lu RH" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2008.03823.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "46" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18680550" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Race, insulin resistance and hepatic steatosis in chronic hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Conjeevaram HS" 1 => "Kleiner DE" 2 => "Everhart JE" 3 => "Hoofnagle JH" 4 => "Zacks S" 5 => "Afdhal NH" 6 => "Wahed AS" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21455" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "80" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17187406" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance predicts response to peginterferon-alpha/ribavirin combination therapy in chronic hepatitis C patients." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Dai CY" 1 => "Huang JF" 2 => "Hsieh MY" 3 => "Hou NJ" 4 => "Lin ZY" 5 => "Chen SC" 6 => "Wang LY" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2008.12.017" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2009" "volumen" => "50" "paginaInicial" => "712" "paginaFinal" => "718" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19231011" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance and geographical origin: major predictors of liver fibrosis and response to peginterferon and ribavirin in HCV-4." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Moucari R" 1 => "Ripault MP" 2 => "Martinot-Peignoux M" 3 => "Voitot H" 4 => "Cardoso AC" 5 => "Stern C" 6 => "Boyer N" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.2009.185074" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2009" "volumen" => "58" "paginaInicial" => "1662" "paginaFinal" => "1669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19671541" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance and response to therapy in patients infected with chronic hepatitis C virus genotypes 2 and 3." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Poustchi H" 1 => "Negro F" 2 => "Hui J" 3 => "Cua IH" 4 => "Brandt LR" 5 => "Kench JG" 6 => "George J" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2007.07.026" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2008" "volumen" => "48" "paginaInicial" => "28" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17977612" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance is associated with liver fibrosis in non-diabetic chronic hepatitis C patients." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Muzzi A" 1 => "Leandro G" 2 => "Rubbia-Brandt L" 3 => "James R" 4 => "Keiser O" 5 => "Malinverni R" 6 => "Dufour JF" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2005" "volumen" => "42" "paginaInicial" => "41" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15726693" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance plays a significant role in liver fibrosis in chronic hepatitis C and in the response to antiviral therapy." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D’Souza R" 1 => "Sabin CA" 2 => "Foster GR" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2005.41403.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2005" "volumen" => "100" "paginaInicial" => "1509" "paginaFinal" => "1515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15984973" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Leandro G" 1 => "Mangia A" 2 => "Hui J" 3 => "Fabris P" 4 => "Rubbia-Brandt L" 5 => "Colloredo G" 6 => "Adinolfi LE" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2006.03.014" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2006" "volumen" => "130" "paginaInicial" => "1636" "paginaFinal" => "1642" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16697727" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C virus-induced hepatocellular steatosis." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Castera L" 1 => "Chouteau P" 2 => "Hezode C" 3 => "Zafrani ES" 4 => "Dhumeaux D" 5 => "Pawlotsky JM" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2005.40898.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2005" "volumen" => "100" "paginaInicial" => "711" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15743372" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting clinical and histologic outcomes based on standard laboratory tests in advanced chronic hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Ghany MG" 1 => "Lok AS" 2 => "Everhart JE" 3 => "Everson GT" 4 => "Lee WM" 5 => "Curto TM" 6 => "Wright EC" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2009.09.007" "Revista" => array:7 [ "tituloSerie" => "Gastroenterology" "fecha" => "2010" "volumen" => "138" "numero" => "1" "paginaInicial" => "136" "paginaFinal" => "146" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19766643" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weight-related effects on disease progression in the hepatitis C antiviral long-term treatment against cirrhosis trial." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Everhart JE" 1 => "Lok AS" 2 => "Kim HY" 3 => "Morgan TR" 4 => "Lindsay KL" 5 => "Chung RT" 6 => "Bonkovsky HL" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2009.05.007" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2009" "volumen" => "137" "paginaInicial" => "549" "paginaFinal" => "557" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19445938" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Steatosis in chronic hepatitis C: friend or foe?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Negro F" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1478-3231.2008.01679.x" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2008" "volumen" => "28" "paginaInicial" => "294" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18290771" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of type 2 diabetes on the development of hepatocellular carcinoma in different viral hepatitis statuses." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Wang CS" 1 => "Yao WJ" 2 => "Chang TT" 3 => "Wang ST" 4 => "Chou P" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1158/1055-9965.EPI-08-1131" "Revista" => array:6 [ "tituloSerie" => "Cancer Epidemiol Biomarkers Prev" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "2054" "paginaFinal" => "2060" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19549812" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Veldt BJ" 1 => "Chen W" 2 => "Heathcote EJ" 3 => "Wedemeyer H" 4 => "Reichen J" 5 => "Hofmann WP" 6 => "De Knegt RJ" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.22251" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "1856" "paginaFinal" => "1862" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18506898" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sustained virological response reduces incidence of onset of type 2 diabetes in chronic hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Arase Y" 1 => "Suzuki F" 2 => "Suzuki Y" 3 => "Akuta N" 4 => "Kobayashi M" 5 => "Kawamura Y" 6 => "Yatsuji H" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.22703" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2009" "volumen" => "49" "paginaInicial" => "739" "paginaFinal" => "744" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19127513" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of weight reduction on liver histology and biochemistry in patients with chronic hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Hickman IJ" 1 => "Clouston AD" 2 => "Macdonald GA" 3 => "Purdie DM" 4 => "Prins JB" 5 => "Ash S" 6 => "Jonsson JR" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.51.1.89" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2002" "volumen" => "51" "paginaInicial" => "89" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12077098" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Hickman IJ" 1 => "Jonsson JR" 2 => "Prins JB" 3 => "Ash S" 4 => "Purdie DM" 5 => "Clouston AD" 6 => "Powell EE" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gut" "fecha" => "2004" "volumen" => "53" "paginaInicial" => "413" "paginaFinal" => "419" ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0255" "etiqueta" => "51." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does a lower insulin resistance affect antiviral therapy response in patients suffering from HCV related chronic hepatitis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Tarantino G" 1 => "Conca P" 2 => "Ariello M" 3 => "Mastrolia M" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gut" "fecha" => "2006" "volumen" => "55" "paginaInicial" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16531544" "web" => "Medline" ] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0260" "etiqueta" => "52." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis, management, and treatment of hepatitis C: an update." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Ghany MG" 1 => "Strader DB" 2 => "Thomas DL" 3 => "Seeff LB" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.22759" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2009" "volumen" => "49" "paginaInicial" => "1335" "paginaFinal" => "1374" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19330875" "web" => "Medline" ] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0265" "etiqueta" => "53." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pioglitazone in chronic hepatitis C not responding to pegylated interferon-alpha and ribavirin." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Overbeck K" 1 => "Genne D" 2 => "Golay A" 3 => "Negro F" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2008.03.033" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2008" "volumen" => "49" "paginaInicial" => "295" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18555553" "web" => "Medline" ] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0270" "etiqueta" => "54." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pioglitazone improves early virologic kinetic response to PEG IFN/RBV combination therapy in hepatitis C genotype 1 naýve patients." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Elgouhari HM" 1 => "Cesario KB" 2 => "López R" 3 => "Zein NN" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Hepatology" "fecha" => "2008" "volumen" => "48" "paginaInicial" => "383A" ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0275" "etiqueta" => "55." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized, double-blind, placebo-controlled study of PPARgamma agonist pioglitazone given in combination with peginterferon and ribavirin in patients with genotype-1 chronic hepatitis C." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Conjeevaram H" 1 => "Burant CF" 2 => "McKenna B" 3 => "Harsh D" 4 => "Kang H" 5 => "Das AK" 6 => "Everett L" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Hepatology" "fecha" => "2008" "volumen" => "48" "paginaInicial" => "384A" ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0280" "etiqueta" => "56." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pioglitazone improves virological response to peginterferon alpha-2b/ribavirin combination therapy in hepatitis C genotype 4 patients with insulin resistance." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Khattab M" 1 => "Emad M" 2 => "Abdelaleem A" 3 => "Eslam M" 4 => "Atef R" 5 => "Shaker Y" 6 => "Hamdy L" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1478-3231.2009.02171.x" "Revista" => array:7 [ "tituloSerie" => "Liver Int" "fecha" => "2010" "volumen" => "30" "numero" => "3" "paginaInicial" => "447" "paginaFinal" => "454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19919569" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0285" "etiqueta" => "57." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pioglitazone as adjuvant therapy in chronic hepatitis C: sequential rather than concomitant administration with pegylated interferon and ribavirin?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Serfaty L" 1 => "Fartoux L" 2 => "Poupon R" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2009.02.014" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2009" "volumen" => "50" "paginaInicial" => "1269" "paginaFinal" => "1271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19395115" "web" => "Medline" ] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0290" "etiqueta" => "58." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of insulin resistance with metformin in naive genotype 1 chronic hepatitis C patients receiving peginterferon alfa2a plus ribavirin." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Romero-Gomez M" 1 => "Diago M" 2 => "Andrade RJ" 3 => "Calleja JL" 4 => "Salmeron J" 5 => "Fernandez-Rodriguez CM" 6 => "Sola R" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.23206" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2009" "volumen" => "50" "paginaInicial" => "1702" "paginaFinal" => "1708" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19845037" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/00000009000000S1/v1_201906221034/S1665268119317351/v1_201906221034/en/main.assets" "Apartado" => array:4 [ "identificador" => "78200" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Module XVII" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/00000009000000S1/v1_201906221034/S1665268119317351/v1_201906221034/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119317351?idApp=UINPBA00004N" ]
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2024 October | 22 | 9 | 31 |
2024 September | 34 | 6 | 40 |
2024 August | 21 | 4 | 25 |
2024 July | 49 | 7 | 56 |
2024 June | 25 | 8 | 33 |
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2024 April | 37 | 6 | 43 |
2024 March | 22 | 7 | 29 |
2024 February | 16 | 6 | 22 |
2024 January | 27 | 3 | 30 |
2023 December | 31 | 5 | 36 |
2023 November | 17 | 3 | 20 |
2023 October | 17 | 4 | 21 |
2023 September | 10 | 2 | 12 |
2023 August | 22 | 3 | 25 |
2023 July | 11 | 3 | 14 |
2023 June | 15 | 5 | 20 |
2023 May | 44 | 0 | 44 |
2023 April | 38 | 0 | 38 |
2023 March | 30 | 4 | 34 |
2023 February | 20 | 3 | 23 |
2023 January | 9 | 12 | 21 |
2022 December | 15 | 15 | 30 |
2022 November | 35 | 11 | 46 |
2022 October | 13 | 8 | 21 |
2022 September | 18 | 7 | 25 |
2022 August | 20 | 5 | 25 |
2022 July | 18 | 4 | 22 |
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2021 November | 8 | 6 | 14 |
2021 October | 15 | 7 | 22 |
2021 September | 6 | 10 | 16 |
2021 August | 9 | 4 | 13 |
2021 July | 9 | 7 | 16 |
2021 June | 11 | 11 | 22 |
2021 May | 7 | 6 | 13 |
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2021 March | 24 | 4 | 28 |
2021 February | 8 | 6 | 14 |
2021 January | 3 | 8 | 11 |
2020 December | 3 | 4 | 7 |
2020 November | 1 | 5 | 6 |
2020 October | 2 | 5 | 7 |
2020 September | 3 | 6 | 9 |
2020 August | 11 | 3 | 14 |
2020 July | 1 | 1 | 2 |
2020 June | 3 | 2 | 5 |
2020 May | 3 | 4 | 7 |
2020 April | 1 | 2 | 3 |
2020 March | 4 | 2 | 6 |
2020 February | 3 | 7 | 10 |
2020 January | 3 | 6 | 9 |
2019 December | 4 | 7 | 11 |
2019 November | 1 | 1 | 2 |
2019 October | 2 | 2 | 4 |
2019 September | 1 | 2 | 3 |
2019 August | 1 | 2 | 3 |
2019 July | 2 | 6 | 8 |
2019 June | 1 | 4 | 5 |