Independent predictors for non-alcoholic fatty liver disease in patients with treatment-naïve chronic hepatitis B

Tuncer, Gulsah; Geyiktepe-Guclu, Ceyda; Bayramlar, Osman Faruk; Bozan, Burcu Atasoy; Yucel, Cigdem; Copur, Betul; Guclu, Kadir Gorkem; Yıldırım, Mustafa; Sengöz, Gonul; Pehlivanoglu, Filiz

doi:10.1590/1806-9282.20231036

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 70 (4) • 2024 • https://doi.org/10.1590/1806-9282.20231036 copy

Independent predictors for non-alcoholic fatty liver disease in patients with treatment-naïve chronic hepatitis B

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

There are limited data on non-alcoholic fatty liver disease in chronic hepatitis B virus infection. We aimed to determine the predictors for non-alcoholic fatty liver disease in patients with treatment-naïve chronic hepatitis B virus infection.

METHODS:

All consecutive treatment-naïve patients with chronic hepatitis B virus infection at the Haseki Training and Research Hospital between October 1, 2021, and September 31, 2022, were retrospectively enrolled. Chronic hepatitis B virus infection is defined by positive serum hepatitis B surface antigen for 6 months or more. Patients with significant alcohol consumption, prolonged steatogenic drug use, malignancy, monogenic hereditary disorders, patients co-infected with hepatitis D virus, hepatitis C virus infection, or human immunodeficiency virus were excluded. Demographic characteristics, anthropometric determinants, laboratory findings, and virological parameters were retrospectively collected from patients’ charts and electronic medical records.

RESULTS:

A total of 457 patients with treatment-naïve chronic hepatitis B virus infection were included in the study. The three multivariate regression models revealed that age (p<0.028), body mass index (p=0.046), diabetes mellitus (p=0.030), hemoglobin (p=0.008), platelet (p=0.012), and triglyceride (p=0.002) in Model 1; body mass index (p=0.033), diabetes mellitus (p<0.001), hemoglobin (p=0.008), platelet (p=0.004), LDL (p=0.023), and HDL (p=0.020) in Model 2; and age (p<0.001), body mass index (p=0.033), hemoglobin (p=0.004), platelet (p=0.004), and HDL (p=0.007) in Model 3 were independent predictors.

CONCLUSION:

Non-alcoholic fatty liver disease was observed in about one-third of patients with chronic hepatitis B virus infection and was positively associated with older age, higher body mass index, presence of comorbid conditions including diabetes mellitus, increased levels of metabolic laboratory parameters, especially serum triglyceride and LDL, and decreased HDL.

KEYWORDS
NAFLD; Hepatitis B; BMI; Hyperlipidemia; Diabetes

Parameters		In total		Patients with NAFLD (n=162)		Patients without NAFLD (n=295)		OR	CI	p-value
Parameters		n	%	n	%	n	%	OR	CI	p-value
Sex, n (%)	Male	244	53.4	94	58.0	150	50.8	0.748	0.508–1.102	0.141
Sex, n (%)	Female	213	46.6	68	42.0	145	49.2			0.141
Underlying diseases, n (%)	Yes	127	27.8	64	39.5	63	21.4	2.405	1.579–3.662	<0.001
Underlying diseases, n (%)	No	330	72.2	98	60.5	232	78.6			<0.001
Diabetes mellitus, n (%)	Yes	44	9.6	26	16	18	6.1	2.942	1.559–5.552	0.001
Diabetes mellitus, n (%)	No	413	90.4	136	84	256	93.9			0.001
Hypertension, n (%)	Yes	75	16.4	36	22.2	39	13.2	1.875	1.137–3.094	0.013
Hypertension, n (%)	No	382	83.6	126	77.8	256	86.8			0.013
Chronic artery diseases, n (%)	Yes	12	2.6	7	4.3	5	1.7	2.636	0.823–8.445	0.091
Chronic artery diseases, n (%)	No	444	97.4	154	95.7	290	98.3			0.091
Chronic kidney disease, n (%)	Yes	8	1.8	2	1.2	6	2	0.602	0.120–3.018	0.533
Chronic kidney disease, n (%)	No	449	98.2	160	98.8	289	98			0.533
Chronic obstructive pulmonary disease, n (%)	Yes	7	1.5	3	1.9	4	1.4	1.373	0.303–6.210	0.702
Chronic obstructive pulmonary disease, n (%)	No	450	98.5	159	98.1	291	98.6			0.702
Neurological disease, n (%)	Yes	8	1.8	2	1.2	6	2	0.602	0.120–3.018	0.533
Neurological disease, n (%)	No	449	98.2	160	98.8	289	98			0.533
Hyperlipidemia, n (%)	Yes	14	3.1	9	5.6	5	1.7	3.412	1.124–10.359	0.022
Hyperlipidemia, n (%)	No	443	96.9	153	94.4	290	98.3			0.022
HBeAg positive, n (%)	Yes	12	2.6	4	2.5	8	2.7	0.908	0.269–3.064	0.877
HBeAg positive, n (%)	No	445	97.4	158	97.5	287	97.3			0.877

Parameters	In total	Patients with NAFLD (n=162)	Patients without NAFLD (n=295)	p-value
Parameters	Median (IQR 25–75)	Median (IQR 25–75)	Median (IQR 25–75)	p-value
Age, years, median (IQR)	43 (36–52)	47 (40–55)	42 (34–51)	<0.001
BMI, median (IQR)	26.3 (23.4–29.3)	28.1 (25.8–31.5)	25.5 (22.9–28.5)	<0.001
HBV-DNA, IU/mL, median (IQR)	892 (131–5920)	572 (88–3730)	1030 (187–7200)	0.021
Hemoglobin, g/dL, median (IQR)	14 (13–15.3)	14.6 (13.2–15.4)	14 (12.6–15.3)	0.014
Platelet /mm³, median (IQR)	232 (196–269)	237 (204–278)	227 (194–259)	0.017
Aspartate aminotransferase (AST), IU/mL, median (IQR)	20 (17–24)	20 (17–25)	20 (17–24)	0.607
Alanine aminotransferase (ALT), IU/mL median (IQR)	20 (15–29)	20 (15–32)	19 (15–28)	0.074
Total bilirubin, mg/dL, median (IQR)	0.44 (0.33–0.64)	0.44 (0.34–0.61)	0.46 (0.33–0.65)	0.538
LDL, mg/dL, median (IQR)	103 (84–128)	110 (86–136)	100 (82–122)	0.003
HDL, mg/dL, median (IQR)	47 (40–56)	45 (36–52)	49 (41–58)	<0.001
Triglyceride, mg/dL, median (IQR)	109 (77–160)	148 (104–193)	95 (71–135)	<0.001
Fasting blood glucose, mg/dL, median (IQR)	94 (88–105)	99 (89–110)	93 (87–103)	0.003
INR, median (IQR)	1.0 (1.0–1.1)	1.0 (1.0–1.0)	1.0 (1.0–1.1)	0.004
Alfa fetoprotein, ng/mL, median (IQR)	2.5 (1.8–3.6)	2.5 (1.8–3.4)	2.6 (1.8–3.6)	0.78
FIB-4 score, median (IQR)	0.8 (0.7–1.2)	0.9 (0.7–1.1)	0.8 (0.6–1.2)	0.967
Fibrosis, median (IQR)	1 (0–1)	0 (0–1)	1 (0–1)	0.647
Hepatic activity index (HAI), median (IQR)	4 (3–5)	4 (3–5)	4 (3–6)	0.636

Parameters	Univariate analysis			Multivariate Model 1			Multivariate Model 2			Multivariate Model 3
Parameters	OR	CI	p	OR	CI	p	OR	CI	p	OR	CI	p
Age	1.029	1.013–1.046	<0.001	1.034	1.004–1.065	0.028	–	–	–	1.048	1.023–1.074	<0.001
Body mass index	1.072	1.028–1.117	0.001	1.049	1.001–1.100	0.046	1.051	1.004–1.101	0.033	1.048	1.004–1.095	0.033
Hypertension	1.875	1.137–3.094	0.014	1.009	0.425–2.394	0.983	–	–	–	–	–	–
Diabetes mellitus	2.942	1.559–5.552	0.001	3.446	1.130–10.515	0.030	5.711	2.075–15.722	<0.001	–	–	–
Hyperlipidemia	3.412	1.124–10.359	0.030	1.248	0.241–6.470	0.792	–	–	–	–	–	–
Hemoglobin	1.165	1.039–1.306	0.009	1.315	1.076–1.608	0.008	1.292	1.068–1.564	0.008	1.336	1.098–1.625	0.004
Platelet count	1.004	1.000–1.007	0.032	1.008	1.002–1.014	0.012	1.008	1.003–1.014	0.004	1.009	1.003–1.015	0.004
Triglyceride	1.011	1.007–1.014	<0.001	1.009	1.003–1.014	0.002	–	–	–	–	–	–
LDL	1.010	1.004–1.016	0.001	1.008	0.998–1.017	0.130	1.010	1.001–1.019	0.023	–	–	–
HDL	0.967	0.952–0.983	<0.001	0.987	0.957–1.017	0.384	0.969	0.943–0.995	0.020	0.963	0.937–0.990	0.007

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author: gorkemguclurd@gmail.com