Current but not past hepatitis B virus infection is associated with a decreased risk of nonalcoholic fatty liver disease in the Chinese population: A case‐control study with propensity score analysis

Abstract

The relation between hepatitis B virus (HBV) infection and fatty liver has been addressed by several observational studies, but their results remain controversial. To date, no study has precisely investigated the association of current and past HBV infection with the risk of nonalcoholic fatty liver disease (NAFLD) in the Chinese population. Therefore, we conducted a hospital-based case-control study in southwestern China to clarify this issue. A total of 631 newly ultrasound-diagnosed NAFLD cases and 2357 controls were selected from 123 243 consecutive patients admitted to a tertiary-care hospital between January 2015 and December 2016. Multivariate logistic regression was employed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A propensity score was developed for adjustment and matching. Subgroup analysis was conducted to identify potential effect modifiers. Current and past HBV infection had an overall prevalence of 9.7% and 55.2%, respectively. In the fully adjusted model, current HBV infection was associated with a decreased risk of NAFLD (OR 0.64; 95% CI 0.42-0.95). A similar inverse association was observed in both propensity-score-adjusted (OR 0.58; 95% CI 0.40-0.86) and propensity-score-matched analyses (OR 0.61; 95% CI 0.40-0.92).The inverse association was stronger in patients with hypertension than in those without (P = .018).No significant association between past HBV infection and NAFLD risk was found. In conclusion, current but not past HBV infection is associated with a decreased risk of NAFLD in the Chinese population. The corresponding biological mechanisms remain to be elucidated.

Hepatitis B Virus Reactivation in a Patient with Nonalcoholic Steatohepatitis 41 Months after Rituximab-containing Chemotherapy

“…In mice with chronic HBV infection, fatty liver reduced HBV replication (21). HBV infection was associated with a decreased risk of NAFLD (10,11). Steatosis in patients with HBV infection was associated with low HBs-Ag and HBV-DNA levels (22,23).…”

“…The prevalence of NAFLD was estimated to be 27.4% in Asia and 24.6-29.7% in Japan (9). Although several studies have reported an association between NAFLD and HBV infection (10,11), the influence of NAFLD on HBV reactivation is unknown. We present the case of a patient who experienced HBV reactivation 41 months after rituximab-based chemotherapy.…”

Chronic hepatitis B and non‐alcoholic fatty liver disease: Conspirators or competitors?

“…Another cross‐sectional study in Taiwan also found a negative association of HBV infection with NAFLD, especially in individuals with BMI >22.4 kg/m2 or age >50 years . To further explore the association between chronic HBV infection and NAFLD, Zhong et al conducted a large case‐control study and found that current HBV infection was associated with a decreased risk of NAFLD (OR = 0.64). Notably, a large cohort study conducted in 2017 among 83,339 patients without initial evidence of NAFLD demonstrated an adjusted HR of 0.83 for NAFLD in HBsAg‐positive individuals compared with the HBsAg‐negative group …”

“…For example, NAFLD and CHB can collectively aggravate liver injury and augment the risk of cirrhosis and HCC, acting as “notorious conspirators” jeopardizing liver health. Conversely, NAFLD appears to be positively associated with diminished HBV seromarkers in patients with CHB, with these patients also exhibiting reduced incidence of lipidemia and NAFLD, suggesting a potential “competitive relationship”. To address this apparent paradox, here we systematically reviewed the research advances related to HBV and NAFLD and attempted to unravel the potential relationship between these disorders.…”

Neutrophil-lymphocyte ratio and mean platelet volume as predictive factors for liver fibrosis and steatosis in patients with chronic hepatitis B

“…Furthermore, everyday clinical practice is faced with the so-far underestimated problem of liver steatosis. The literature still lacks consistent data concerning fatty liver in patients with HBV, yet most of the papers show that HBV patients display less advanced stages of steatosis than the non-infected population [12,13,14]. Hence the subject of this study, the aim of which was to determine whether NLR values are significantly varied in HBV patients and healthy individuals.…”