Inverse Association between Hepatitis B Virus Infection and Fatty Liver Disease: A Large-Scale Study in Populations Seeking for Check-Up

Abstract

BackgroundAlthough many studies have attempted to clarify the association between hepatitis B virus (HBV) infection and fatty liver disease, no prior studies have emphasized the relationship of HBV and fatty liver regarding different demographics of age and body mass index (BMI).AimTo investigate the correlation of HBV and fatty liver in the different demographics of age and BMI.MethodsWe enrolled consecutive subjects who had received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009 and ultrasonography was used to diagnose fatty liver according to the practice guidelines of the American Gastroenterological Association.ResultsAmong the 33,439 subjects enrolled in this study, fatty liver was diagnosed in 43.9% of the population and 38.9% of patients with chronic HBV infection. Multivariate analysis showed that BMI, age, waist circumference, systolic blood pressure, fasting glucose, cholesterol, alanine aminotransferase (ALT) levels, and platelet counts were positively associated, while hepatitis B surface antigen (HBsAg) positivity was inversely associated with fatty liver, especially for subjects with BMI>22.4 kg/m2 and age>50 years. On the contrary, HBV infection was positively correlated with the presence of elevated serum ALT levels in subjects with fatty liver disease regardless of their age and BMI.ConclusionsMetabolic factors are important determinants for the prevalence of fatty liver. Patients with HBV infection were inversely associated with fatty liver disease than the general population, especially in older and obese patients. Furthermore, metabolic factors and HBV infection were associated with elevated serum ALT levels in fatty liver disease.

Interactions of Hepatitis B Virus Infection with Nonalcoholic Fatty Liver Disease: Possible Mechanisms and Clinical Impact

“…However, according to the current reports [7,8,11,17,18,[103][104][105][106][107][108][109][110], the prevalence of NAFLD in CHB ranges widely from 13.6 to 59.3 % ( Table 1). The significant divergence may be due to the differences in ethnicity, demography, and the precise criterion in the studies.…”

“…Such an inverse relationship between CHB and MS is consistent with the result from another large population-based crosssectional study conducted in Taiwan, in which a total of 53,528 subjects were enrolled [111]. If further stratified by age and BMI, according to a large-scale cross-sectional study of 33,439 Taiwan CHB patients, those who were over 50 years old or with body mass index (BMI) over 22.4 kg/m 2 presented a more pronounced negative relationship with fatty liver disease than those who were not [109]. These findings may be attributable to the observation that HBV DNA is positively associated with adiponectin [110]: The decrease in adiponectin, a key regulator of insulin sensitivity secreted by adipose tissue, is confirmed to be a causative factor for IR and the pathogenesis of NAFLD.…”

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

“…Current hepatitis B virus (HBV) infection is a leading aetiological factor of liver cirrhosis and HCC worldwide, especially in Africa and the Western Pacific region . Recently, several observational studies have paid attention to the topic of current HBV infection and fatty liver . However, their findings are rather inconclusive.…”

Hepatitis B and concomitant hepatic steatosis

“…In a more recent study by Enomoto et al (17), they found a low frequency histological hepatic steatosis in patients with a high HBV-DNA level and concluded that there is unlikely an association between HBV infection and hepatic steatosis. In another large scale study in Taiwan by Cheng et al (18) which recruited a total of 33,439 subjects, they showed an inverse relationship between prevalence of fatty liver and positive HBsAg status in subjects older than 50 years and no significant association between HBV infection and fatty liver in subjects younger than 50 years. Although fatty liver was diagnosed via ultrasound and no liver biopsy was performed, the overwhelming statistics on these recent study showed that association between HBV infection and hepatic steatosis is not as strong as what previously thought.…”