Prevalence and risk factors of hepatic steatosis and its impact on liver injury in Chinese patients with chronic hepatitis B infection

Abstract

Background and Aims: The clinical significance of hepatic steatosis in chronic hepatitis B infection (CHB) is unclear. The aims of this study were thus to investigate the prevalence and risk factors for hepatic steatosis in patients with CHB and its relationship with liver injury. Methods: Consecutive patients with biopsy-proven CHB at Hangzhou Sixth People's Hospital between January 2005 and June 2007 were included. Patients co-infected with other viruses or suffering from liver disease of any other cause were excluded. Liver steatosis, necroinflammation and fibrosis were assessed by both Brunt and Scheuer classifications. Results: A total of 1915 patients (1497 men) with a mean age of 31 Ϯ 9.5 years were analyzed. Hepatic steatosis was present in 260 (14%) patients. The steatosis involved < 33% of hepatocytes in 90% of cases, and was more frequent among men than women (15% vs 8%, P < 0.001). Two-thirds (178 of 260) of patients with steatosis were hepatitis B e antigen (HBeAg)-positive, but there was no correlation with either serum HBeAg status or hepatitis B virus DNA titer. Degree of inflammation and fibrosis were more mild among those with steatosis than those without. Multivariate analysis showed that steatosis was independently associated with body mass index, serum triglyceride, apolipoprotein B, uric acid, and fasting blood glucose. However, fibrosis was only independently associated with age and inflammatory grade, and the latter associated with viral load and fibrosis stage. Conclusions: Hepatic steatosis is common in CHB, it is associated with metabolic factors not viral ones, and does not appear to affect the severity of liver disease.

Hepatic Steatosis: Prevalence and Host/Viral Risk Factors in Iranian Patients with Chronic Hepatitis B Infection

“…Likewise, in other reports, no significant association was found between the stage of fibrosis and the severity of steatosis (Bondini et al, 2007;Peng et al, 2008;Rastogi et al, 2011). However, by univariate analysis, when the cut off of >3 was used as criterion decision for severe fibrosis, a strong relationship between fibrosis and HS was achieved (p=0.026), a finding similar to two reports (Shi et al, 2008;Petta et al, 2011). Moreover, on multivariate analysis when we compared the HIA scores with the stages of fibrosis in both groups of patients, higher stages of fibrosis (>3) were associated with HAI scores of necroinflammation (P value<0.001), consistent with other reports of patients with CHC and CHB (Altlparmak et al, 2005;Peng et al, 2008).…”

Impact of fatty liver on hepatitis B virus replication and virologic response to tenofovir and entecavir

“…In epidemiological surveys, NAFLD has been reported to be related to host factors much more than viral factors (3)(4)(5)(6)8,(10)(11)(12). No significant difference was detected between patients with and without NAFLD in the aforementioned studies.…”

“…However, a negative correlation between NAFLD and serum HBV DNA levels has also been reported in a meta-analysis (7). When the literature regarding the relation between NAFLD and chronic HBV infection was reviewed, the result seems to be inconclusive (3)(4)(5)(6)(7)(8)(10)(11)(12)(13)(14)(15)(16)(17)(18). We think that the cause of the results that were obtained in those studies may relate to the lack of subgroup analysis.…”

“…Approximately onethird (13.6-44.4%) of patients with chronic hepatitis B virus (HBV) infection have been reported to have NAFLD (2)(3)(4)(5)(6)(7)(8). Despite studies that claim an increase in NAFLD in the presence of active viral replication in patients with chronic HBV infection, there are studies that report suppression of viral replication in NAFLD (9,10).…”

“…Despite studies that claim an increase in NAFLD in the presence of active viral replication in patients with chronic HBV infection, there are studies that report suppression of viral replication in NAFLD (9,10). Many epidemiological studies have reported no difference regarding HBV replication between patients with NAFLD and those without NAFLD (3)(4)(5)(6)8,(10)(11)(12)(13). However, a negative correlation between NAFLD and serum HBV DNA levels has also been reported in a meta-analysis (7).…”