Our study demonstrated that PAGE-B is applicable to Asian chronic hepatitis B patients receiving ETV or TDF therapy. The PAGE-B showed similar predictive performance to GAG-HCC and CU-HCC.

Summary Background Population‐based data are lacking regarding whether fatty liver is a risk factor for hepatocellular carcinoma (HCC) and mortality in patients with chronic viral hepatitis. Aim To investigate the association of fatty liver with HCC incidence and mortality in patients with chronic viral hepatitis using a nationwide cohort Methods We included 57,385 patients with chronic hepatitis B (CHB) or chronic hepatitis C (CHC) who underwent health examinations. The patients were divided into three groups: no fatty liver, fatty liver index (FLI) <30, grade 1 (G1) fatty liver: 30≤ FLI <60, and grade 2 (G2) fatty liver: FLI >60. Results During a median 8.4‐year follow‐up, we documented 3496 HCC cases and 4146 deaths. Compared to patients with no fatty liver (n = 35,018), the risk of HCC was significantly higher in patients with G1 fatty liver (n = 14,544) (adjusted hazard ratio [aHR] = 1.50, 95% confidence interval [CI] = 1.38‐1.64) and G2 fatty liver (n = 7,823) (aHR = 1.88, 95% CI = 1.67‐2.12). The risk of mortality was significantly higher in patients with G1 fatty liver (aHR = 1.53, 95% CI = 1.41‐1.66) and G2 fatty liver (aHR = 2.16, 95% CI = 1.94‐2.42) compared to patients with no fatty liver. Conclusions Concurrent fatty liver was associated with a higher risk of HCC and mortality in patients with chronic viral hepatitis. Our results suggest the importance of management of fatty liver to reduce the risks of HCC and mortality in patients with chronic viral hepatitis.

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Metabolic dysfunction‐associated fatty liver disease (MAFLD) can coexist with chronic viral hepatitis. MAFLD is a heterogeneous disease because the diagnostic criteria include various metabolic traits. We aimed to identify patients at high risk of poor long‐term outcomes based on MAFLD subgroups in chronic viral hepatitis patients. We evaluated 63 273 chronic hepatitis B and C patients. Patient with a fatty liver index ≥30 was defined to have hepatic steatosis. MAFLD was defined as the presence of hepatic steatosis with any one of the following three conditions, overweight/obesity, type 2 diabetes or ≥2 metabolic risk factors. The prevalence of MAFLD was 38.4% (n = 24 290). During a median 8.8‐year follow‐up, 1839 HCCs and 2258 deaths were documented in MAFLD patients. Among MAFLD patients, diabetes could identify patients at high risk of HCC and mortality, whereas overweight/obesity and metabolic risk factors did not. Compared with non‐MAFLD patients, risk of HCC and mortality was significantly higher in diabetic MAFLD patients (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] = 1.26‐1.43 for HCC; aHR = 1.15, 95% CI = 1.08‐1.22 for mortality). Risk of HCC and mortality was significantly higher in diabetic MAFLD patients (aHR = 1.40, 95% CI = 1.26‐1.55 for HCC; aHR = 1.77, 95% CI = 1.63‐1.93 for mortality) compared with non‐diabetic MAFLD patients. Diabetic MAFLD is associated with increased risk of HCC and mortality among chronic viral hepatitis patients. Our findings highlight the need for close surveillance and effective treatment for these high‐risk patients to reduce HCC and mortality in patients with chronic viral hepatitis.

We investigated the impact of short-term changes in general and central fatness on the risk of hepatocellular carcinoma (HCC) in a large, population-based cohort. We screened 7 221 479 subjects who underwent health examinations provided by the

LINKED CONTENT This article is linked to Kim et al papers. To view these articles, visit https://doi.org/10.1111/apt.16706 and https://doi.org/10.1111/apt.16732

Background: Body weight variability is thought to be an indicator of poor health outcomes, including cardiovascular disease (CVD) and mortality. Given that the vast majority of NAFLD patients have difficulty maintaining weight loss and CVD is closely associated with NAFLD, the investigation of the influence of body weight variability on CVD and mortality in NAFLD patients is crucial to prevent the deleterious consequences of NAFLD. We investigated the association between body weight variability and the risks of CVD and mortality in patients with NAFLD using large-scale, nationwide cohort data. Methods: We included 726,736 individuals with NAFLD who underwent a health examination provided by the Korean National Health Insurance System between 2009 and 2010, with follow-up through the end of 2017. NAFLD was defined as a fatty liver index ≥60, after excluding excess alcohol intake, viral hepatitis, and alcoholic cirrhosis. Significant liver fibrosis was defined as a BARD score ≥2. Body weight variability was assessed using four indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed. Results: During a median 8.1-year follow-up , we documented 11,358, 14,714, and 22,164 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively. Body weight variability was associated with an increased risk of MI, stroke, and mortality after adjusting for confounding variables. The hazard ratios (HRs) (95% confidence intervals) for the highest quartile, compared with the lowest quartile, of VIM for body weight were 1.15 (1.10–1.20), 1.22 (1.18–1.26), and 1.56 (1.53–1.62) for MI, stroke, and all-cause mortality, respectively. When examined jointly, the risk of outcomes was highest among NAFLD patients with both significant liver fibrosis and the highest VIM for body weight.Conclusions: Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in NAFLD patients. Appropriate interventions to maintain a stable weight could positively affect health outcomes in NAFLD patients.