Metabolic Risk Factors of Developing Liver Steatosis among Patients with Chronic Hepatitis B: A National Cohort from...

The coexistence of liver steatosis in patients with chronic viral hepatitis B (CHB) is growing relevant as the global epidemic of obesity and type 2 diabetes mellitus (T2DM). The aim of this study was to identify the metabolic risk factors linked to steatotic liver disease (SLD) in Romanian patients with CHB.

In this prospective study, we evaluated 320,000 individuals in the LIVE(RO)2 nationwide screening program in Romania from 2021 to 2023. The majority of the patients had undergone transient elastography using controlled attenuation parameter (CAP) to diagnose liver steatosis, and they belonged to vulnerable categories. Exclusion criteria included heavy alcohol consumption, any other liver disease unrelated to CHB, and the lack of CAP evaluation.

5,321 individuals (1.67%) were found with CHB in the screening program. In the final analysis we included 1,970 patients, with a mean age of 55.87±13.84 years; 57.9% of them were males, with a mean body mass index (BMI) level of 27.26 kg/m², and 61.9% of the patients were vulnerable. The prevalence of SLD was 42.2% in the group of vulnerable individuals, compared with non-vulnerable participants, who had a prevalence of SLD of 26.4%. Moreover, patients with vulnerable conditions have a higher prevalence of T2DM (11.5%), hypertension (41.3%), and raised BMI levels ≥25 kg/m² (71.3%). In our study, vulnerable subjects had a higher prevalence of hepatitis B virus e antigen (HBeAg) positivity of 3%, and it was found to be a protective risk factor for hepatic steatosis development (aOR=0.397). Also, these patients had a higher prevalence of severe liver fibrosis (≥ F3) of 17.1%, compared with those non-vulnerable, with a prevalence of 9.7% of severe liver fibrosis. More than that, we find that the presence of HBeAg-positive increases the risk of severe liver fibrosis progression 6 times higher.

In our study we found a prevalence of hepatic steatosis of 42.2% in the cohort of vulnerable untreated patients with CHB, and the prevalence of severe fibrosis was 17.1%. Presence of HBeAg-positive was found to be a protective risk factor for hepatic steatosis but accelerates the development of severe fibrosis along with T2DM, which is more common in the vulnerable CHB cohort.