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Hepatic steatosis and metabolic risk factors among patients with chronic hepatitis B: The multicentre, prospective
Yong-Wen Leow1, Wah-Kheong Chan1, George Boon-Bee Goh2
1Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Insights
Chronic hepatitis B (CHB) patients with hepatic steatosis show increased liver disease severity and cardiovascular disease (CVD) risk, similar to non-alcoholic fatty liver disease (NAFLD). Early diagnosis and management are crucial for better outcomes.
Area of Science:
- Hepatology
- Cardiology
- Metabolic Diseases
Background:
- Non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are prevalent liver conditions.
- Hepatic steatosis, or fatty liver, can coexist with CHB and may influence disease progression.
- Cardiovascular disease (CVD) risk is a significant concern in patients with chronic liver disease.
Purpose of the Study:
- To compare liver disease severity, metabolic profiles, and CVD risk in CHB patients with and without hepatic steatosis versus NAFLD patients.
- To investigate the prevalence of hepatic steatosis in a cohort of Asian CHB patients.
- To assess the association between hepatic steatosis and CVD risk in CHB and NAFLD.
Main Methods:
- Prospective enrollment of NAFLD and CHB patients from 10 Asian centers.
- FibroScan assessment including controlled attenuation parameter (CAP) for hepatic steatosis diagnosis (CAP >248 dB/m).
- Framingham risk score utilized for CVD risk assessment; statistical analysis of liver enzymes, CAP, liver stiffness, metabolic syndrome, and CVD risk.
Main Results:
- A high prevalence of hepatic steatosis (59%) was observed in CHB patients.
- A significant stepwise increase in liver disease markers (ALT, AST, GGT, CAP, LSM) was noted from CHB without steatosis to CHB with steatosis to NAFLD.
- Metabolic syndrome and CVD risk increased progressively across the groups, with very high/extreme CVD risk in 48% of CHB with steatosis and 61% of NAFLD patients.
Conclusions:
- Hepatic steatosis is common in CHB patients and is associated with more severe liver disease.
- CHB patients with hepatic steatosis exhibit increased metabolic syndrome prevalence and CVD risk.
- Diagnosis and management of hepatic steatosis in CHB patients are essential for addressing metabolic risk factors and improving long-term outcomes.
Abstract:
We aimed to compare the severity of liver disease, metabolic profile and cardiovascular disease (CVD) risk of chronic hepatitis B (CHB) patients with and without hepatic steatosis and patients with non-alcoholic fatty liver disease (NAFLD). Patients with NAFLD and CHB were prospectively enrolled from 10 Asian centres. Fibroscan was performed for all patients and hepatic steatosis was defined based on controlled attenuation parameter >248 dB/m. CVD risk was assessed using the Framingham risk score. The data for 1080 patients were analysed (67% NAFLD, 33% CHB). A high proportion (59%) of CHB patients had hepatic steatosis. There was a significant stepwise increase in alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, controlled attenuation parameter and liver stiffness measurement, from CHB patients without hepatic steatosis to CHB patients with hepatic steatosis to NAFLD patients (p < 0.001 for all comparisons). There was a significant stepwise increase in the proportion of patients with metabolic syndrome and in CVD risk, with very high or extreme CVD risk seen in 20%, 48% and 61%, across the groups (p < 0.001 between CHB patients with and without hepatic steatosis and p < 0.05 between CHB patients with hepatic steatosis and NAFLD patients). In conclusion, there was a high proportion of CHB patients with hepatic steatosis, which should be diagnosed, as they may have more severe liver disease, so that this and their metabolic risk factors can be assessed and managed accordingly for a better long-term outcome.
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