Fatty liver is associated with advanced fibrosis but does not predict adverse outcomes in patients with chronic hepatitis B

Wong, Sui‐Weng; Chan, Wah‐Kheong; Mohamed, Rosmawati

doi:10.1111/jvh.13361

Cited by 21 publications

(31 citation statements)

References 27 publications

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“…All these findings concur with the rising trend of global and Asian prevalence of NAFLD. 2,5 The independent risk factors of concurrent NAFLD in CHB patients mainly included sex, 12,14,17 age, 7,17,19 body mass index (BMI), 12,14,15,19,21,28 disordered glucose metabolism, 12,15,16,23,24,28,31 dyslipidemia, [10][11][12]15,19,21,23,24,28 and uric acid, 15,19 which are also risk factors of NAFLD in general population. 32 Most cross-sectional studies of CHB patients only did not find HBV markers, including hepatitis B e antigen (HBeAg) and HBV DNA, were independent risk factors of hepatic steatosis.…”

Section: Pre Valen Ce and In Ciden Ce Of Con Current Nafld In Chb Pat...mentioning

confidence: 99%

“…Many cross-sectional studies did not find a correlation between NAFLD and HBV DNA levels. 7,11,12,14,15,23,24,[28][29][30][31] But a crosssectional study of 204 CHB patients from Mainland China showed that mean HBV DNA levels were significantly lower in patients with steatosis than in those without (3.29 log 10 IU/ml vs. 5.61 log 10 IU/ ml, p = 0.0081). 16 Similarly, another cross-sectional study of 3212 patients with chronic HBV infection from Mainland China demonstrated that patients with steatosis had lower percentages of serum HBeAg-positive and detectable HBV DNA, and intrahepatic HBsAgand HBcAg-positive staining than those without (all p < 0.001).…”

Section: Concurrent Nafld Might Inhibit Hbv Replicationmentioning

confidence: 99%

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Impact of NAFLD on the outcome of patients with chronic hepatitis B in Asia

Yang

Wei

2022

Liver International

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Hepatitis B virus (HBV) infection and nonalcoholic fatty liver disease (NAFLD) are two major causes of chronic liver disease (CLD) that can cause liver cirrhosis and hepatocellular carcinoma (HCC). 1,2 Although vaccination has dramatically reduced new HBV infection, WHO estimated 3.5% of the population worldwide (257 million people) were chronically infected with HBV in 2015. 3 Most Asian regions are medium to high prevalence areas of HBV infection. 4 Nowadays, NAFLD is the most common CLD in the world, with a global prevalence of about 25%. 2 Accompanied by the epidemic of obesity and change of lifestyle, the burden of NAFLD in Asia continues to increase and the prevalence is about 29%. 5 It is a trend to superimpose NAFLD on chronic HBV infection in Asia.Recently, the international fatty liver expert group proposed a new name as metabolic dysfunction-associated fatty liver disease (MAFLD), which partially overlaps with NAFLD. 6 This paper still uses the naming and definition of NAFLD because of most data coming from NAFLD related studies. We will review the epidemiology of concurrent NAFLD in chronic hepatitis B (CHB) patients and focus on the impact of concurrent NAFLD on the outcome of CHB patients in Asia.

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Section: Pre Valen Ce and In Ciden Ce Of Con Current Nafld In Chb Pat...mentioning

confidence: 99%

Section: Concurrent Nafld Might Inhibit Hbv Replicationmentioning

confidence: 99%

Impact of NAFLD on the outcome of patients with chronic hepatitis B in Asia

Yang

Wei

2022

Liver International

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“…Accumulating evidence suggests an increased risk of advanced fibrosis and long-term adverse prognosis in CHB patients with NAFLD. Our cross-sectional study found that CHB patients with steatosis had less severe fibrosis than those without steatosis[ 51 ]; but in prospective cohort studies, the baseline severity of steatosis was associated with more progressive fibrosis[ 52 - 54 ]. Furthermore, Charatcharoenwitthaya et al [ 25 ]reported that steatohepatitis but not simple steatosis was an independent predictor of significant, advanced fibrosis.The additive effect of steatosis has also been reported in the progression of fibrosis.…”

Section: Progression and Outcomes Of Chb With Nafldmentioning

confidence: 99%

“…Liver conditionsincluding NASH and advanced fibrosis were found to have additive effects on event-free survival (HCC, decompensation and transplantation)[ 44 ]. Wong et al [ 52 ] reported that steatosis had no direct predictive effect on these events including cardiovascular events, liver-related complications, malignancy and mortality.…”

Section: Progression and Outcomes Of Chb With Nafldmentioning

confidence: 99%

Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion

Shi¹,

Yang²,

Fan³

2021

WJG

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With the increasing incidence of obesity and metabolic syndrome worldwide, concomitant nonalcoholic fatty liver disease (NAFLD) in patients with chronic hepatitis B (CHB) has become highly prevalent. The risk of dual etiologies, outcome, and mechanism of CHB with concomitant NAFLD have not been fully characterized. In this review, we assessed the overlapping prevalence of metabolic disorders and CHB, assessed the risk of advanced fibrosis/hepatocellular carcinoma in CHB patients concomitant with NAFLD, and discussed the remaining clinical issues to be addressed in the outcome of such patients. We also explored the possible roles of hepatitis B virus in the development of steatosis and discussed difficultiesof histological evaluation. For CHB patients, it is important to address concomitant NAFLD through lifestyle management and disease screening to achieve better prognoses. The assessment of progressive changes and novel therapies for CHB patients concomitant with NAFLD deserve further research.

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“…19 Several studies have reported outcomes in patients with NAFLD and CHB, mainly in single centre and/or Asian cohorts (ie, Hong Kong, Israel, Malaysia). 12,20,21 However, there are limited published data on the utility of CAP in viral hepatitis, especially in a more diverse patient cohort. 18,22,23 Liver inflammation in patients with CHB and NAFLD may have a synergistic impact on the risk of fibrosis and liver-related mortality.…”

Section: Introductionmentioning

confidence: 99%

Severe Hepatic Steatosis Is Associated With Low-Level Viremia and Advanced Fibrosis in Patients With Chronic Hepatitis B in North America

Patel

Haylock‐Jacobs

et al. 2022

Gastro Hep Advances

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BACKGROUND AND AIMS:The obesity epidemic has increased the risk of nonalcoholic fatty liver disease (NAFLD) in both the general and chronic hepatitis B (CHB) populations. Our study aims to determine the prevalence of NAFLD in patients with CHB based on controlled attenuation parameter (CAP) and the epidemiological, clinical, and virological factors associated with severe hepatic steatosis. METHODS: The Canadian Hepatitis B Network cohort was utilized to provide a cross-sectional description of demographics, comorbidities, antiviral treatment, and hepatits B virus (HBV) tests. Liver fibrosis and steatosis were measured by transient elastography and CAP, respectively. Any grade and severe steatosis were defined as CAP >248 and >280 dB/m, respectively. Advanced liver fibrosis was defined as transient elastography measurement >10.7 kPa. RESULTS: In 1178 patients with CHB (median age: 47.4%, 57.7% males, 75.7% Asian, 13% African, 6.5% White, 86% HBV e antigen negative, median HBV DNA of 2.44 log 10 IU/ mL, 42.7% receiving treatment), the prevalence of any grade and severe steatosis was 53% and 36%, respectively. In the multivariate analysis, obesity was a significant predictor for severe steatosis (adjusted odds ratio: 5.046, 95% confidence interval: 1.22-20.93). Severe steatosis was a determinant associated with viral load (adjusted odds ratio: 0.385, 95% confidence interval: 0.20-0.75, P < .01; r ¼ À0.096, P ¼ .007) regardless of antiviral therapy, age, and alanine aminotransferase levels. CONCLUSION: In this large multiethnic CHB population, hepatic steatosis is common. Severe steatosis is independently associated with higher fibrosis, but negatively with HBV DNA, regardless of antiviral therapy history.

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Fatty liver is associated with advanced fibrosis but does not predict adverse outcomes in patients with chronic hepatitis B

Cited by 21 publications

References 27 publications

Impact of NAFLD on the outcome of patients with chronic hepatitis B in Asia

Impact of NAFLD on the outcome of patients with chronic hepatitis B in Asia

Chronic hepatitis B infection with concomitant hepatic steatosis: Current evidence and opinion

Severe Hepatic Steatosis Is Associated With Low-Level Viremia and Advanced Fibrosis in Patients With Chronic Hepatitis B in North America

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