Prevalence of steatosis and insulin resistance in patients with chronic hepatitis B compared with chronic hepatitis C and non-alcoholic fatty liver disease

• Metabolic risk factors and steatosis may coexist with HBV chronic infection.
• In CHB, insulin resistance and steatosis are related to host metabolic risk factors.
• In CHB, metabolic risk factors are not associated with the severity of fibrosis.

The association of NAFLD with chronic hepatitis C (CHC) has been extensively studied but little is known about its coexistence with chronic hepatitis B (CHB).AimsTo investigate the prevalence and determinants of steatosis and insulin resistance (IR) in CHB and its consequences on liver injury compared with CHC and NAFLD.MethodsPatients with CHB (N = 110), CHC (N = 111) and NAFLD (N = 136) were evaluated by biomarkers of steatosis (SteatoTest > 0.38 as a surrogate for steatosis > 5%), IR (HOMA-IR > 2.7 as a surrogate for IR) and fibrosis (FibroTest > 0.48 as a surrogate for significant fibrosis, ≥ F2).ResultsHOMA-IR gradually increased in CHB, CHC and NAFLD: 2.3 ± 1.8; 3 ± 2.6 and 3.8 ± 2.7 (p < 0.001). The prevalence of steatosis > 5% was 21% (CHB), 43% (CHC) and 82% (NAFLD), (p < 0.001). The prevalence of fibrosis ≥ F2 was 10% (CHB), 42% (CHC) and 21% (NAFLD), p < 0.001.In CHB, IR was related to host and not viral factors. CHB patients with steatosis had higher BMI (29 ± 5.7 kg/m2 vs. 24 ± 4 kg/m2, p < 0.001), waist circumference (96 ± 14 cm vs. 84 ± 11 cm, p = 0.001) and HOMA-IR (3.9 ± 2.6 vs. 1.8 ± 1.2, p < 0.001) than those without steatosis. HOMA-IR independently predicted steatosis in CHB (OR = 1.9, 95% CI, 1.09–3.27, p < 0.05) and CHC (OR = 1.38; 95% CI, 1.07–1.78, p < 0.02). In CHB, metabolic risk factors and HOMA-IR were not associated with significant fibrosis. HOMA-IR was an independent predictor of fibrosis in CHC.ConclusionsSteatosis may co-exist in CHB patients but with a lower prevalence than in CHC and NAFLD. In CHB steatosis is related to host and not viral factors, and is not associated with the severity of fibrosis.