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Risk Factors of Metabolic Dysfunction-associated Steatotic Liver Disease in a Cohort of Patients With Chronic
Maria Kalafateli1, Roberta Forlano2, Eleanor Barnes3
1Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom; Department of Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in chronic hepatitis B (CHB) patients and worsens liver fibrosis. Screening strategies vary, but BMI and type 2 diabetes can indicate MASLD presence.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) frequently coexist, yet data on their combined prevalence and impact on liver disease severity remain conflicting.
- Investigating the discrepancies in prevalence and disease severity associated with the co-occurrence of CHB and MASLD is crucial for understanding patient outcomes.
Purpose of the Study:
- To investigate the prevalence and impact of MASLD in a large European cohort of patients with CHB.
- To identify factors associated with MASLD and advanced fibrosis in this population.
- To evaluate the effectiveness of current screening strategies and diagnostic biomarkers.
Main Methods:
- A multicenter study involving 1709 patients with CHB across 19 European centers.
- Data collection included patient demographics, BMI, ferritin levels, type 2 diabetes status, and liver fibrosis assessment (Fibrosis-4, liver stiffness measurement).
- A survey assessed standard of care for MASLD screening in CHB patients across participating centers.
Main Results:
- MASLD was present in 42.3% of CHB patients, with higher prevalence of advanced fibrosis (25.4%) compared to those without MASLD (13.7%).
- Independent predictors of MASLD included higher BMI, ferritin levels, and type 2 diabetes. Advanced fibrosis was associated with MASLD, BMI, elevated ALT, lower platelets, insulin treatment, and antiviral therapy.
- During follow-up, only patients without MASLD showed significant improvement in liver stiffness; biomarkers demonstrated moderate performance in predicting fibrosis.
Conclusions:
- MASLD is highly prevalent in CHB patients and significantly aggravates liver fibrosis, increasing disease severity.
- Inconsistent screening strategies highlight the need for improved diagnostic approaches, though BMI, ferritin, and type 2 diabetes can suggest MASLD.
- Current biomarkers for fibrosis prediction show only moderate efficacy, necessitating further research into more accurate diagnostic tools.
Background & Aims:
Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) commonly co-exist, with conflicting data in prevalence and disease severity. We aimed to investigate these discrepancies.
Methods:
This multicenter study included consecutive patients with CHB from 19 European centers. A survey on standard of care for MASLD screening in CHB was circulated.
Results:
A total of 1709 patients with CHB were included; median age, 53 years (interquartile range [IQR], 42-64); males, 60.7%; body mass index (BMI), 25.6 kg/m2 (IQR, 14-63 kg/m2); and 57.3% White. MASLD prevalence (1510 consecutive patients) was 42.3%. BMI (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19-1.36), ferritin (OR, 1.00; 95% CI, 1.00-1.00) and type 2 diabetes (OR, 2.60; 95% CI, 1.12-6.02) were independently associated with MASLD. The prevalence of advanced fibrosis was 18% (255/1420) in the whole cohort, 25.4% (162/639) among patients with CHB with MASLD, and 13.7% in those without MASLD. Independent predictors of advanced fibrosis were MASLD (OR, 2.76; 95% CI, 1.50-5.05), BMI (OR, 1.08; 95% CI, 1.02-1.15), alanine transaminase (OR, 1.01; 95% CI, 1.00-1.03), lower platelets (OR, 0.99; 95% CI, 0.98-0.99), insulin treatment (OR, 13.88; 95% CI, 2.95-65.28), and long-term antivirals (OR, 4.86; 95% CI, 2.40-9.85). During follow-up (48 months), only patients without MASLD showed significant liver stiffness measurement improvement over time (P < .001). Among patients with MASLD, Fibrosis-4 and liver stiffness measurement performed moderately at predicting advanced fibrosis (area under the receiver operating characteristic curve = 0.71 vs 0.70; P = .38) against histology. As standard of care, 68.4% of centers screened all patients with CHB for MASLD; 52.6% followed the same treatment indication in those with CHB and MASLD vs CHB only.
Conclusions:
In this large European cohort, MASLD and fibrosis were highly prevalent among patients with CHB, whereas MASLD aggravated liver fibrosis. Though screening strategies remain inconsistent, ferritin levels, increased BMI, and type 2 diabetes may inform on the presence of MASLD. Biomarkers showed modest performance in predicting fibrosis.
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