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Published in: BMC Gastroenterology 1/2024

Open Access 01-12-2024 | Hepatitis B | Research

Association of chronic hepatitis B infection with hepatic steatosis and injury in nonalcoholic fatty liver disease children

Authors: Lu Wang, Chang Lu, Yuncong Zhang, Qingsheng Liang, Jie Zhang

Published in: BMC Gastroenterology | Issue 1/2024

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Abstract

Background

The influence of chronic hepatitis B infection (CBI) on hepatic steatosis, necroinflammation, and fibrosis in nonalcoholic fatty liver disease (NAFLD) population was unclear. We aimed to investigate the effect of CBI on hepatic steatosis and assess the association between NAFLD co-existed CBI and hepatic injury in NAFLD pediatric population.

Methods

Consecutive hospitalized children with biopsy-proven NAFLD with or without CBI were included. Hepatic steatosis, necroinflammation and fibrosis were evaluated by NASH CRN system and/or METAVIR scoring system, appropriately. Using multivariate logistic analysis, we identified variables associated with hepatic steatosis and liver injury.

Results

Of 223 biopsy-proven NAFLD children, 161 were NAFLD without CBI, and 62 were NAFLD co-existed CBI. Grouped by mild, moderate and severe hepatic steatosis, there was an inverse association between CBI and the severity of hepatic steatosis [odd ratio (OR) 0.037, 95% confidence interval (CI) 0.014–0.098]. In addition, we explored the relationship between CBI and hepatic necroinflammation and fibrosis in NAFLD children. Hepatic necroinflammation and fibrosis, respectively, were divided into two groups according to severity. And CBI was positively associated with hepatic necroinflammation (OR 6.125, 95%CI 1.958–19.158). However, there was no statistically independent association between CBI and significant hepatic fibrosis.

Conclusions

CBI was inverse associated with the grade of steatosis and positively associated with severe hepatic necroinflammation, and does not appear to affect significant hepatic fibrosis in pediatric NAFLD children.
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Literature
1.
go back to reference Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84.CrossRefPubMed Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84.CrossRefPubMed
2.
go back to reference Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut. 2009;58(11):1538–44.CrossRefPubMed Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut. 2009;58(11):1538–44.CrossRefPubMed
3.
go back to reference Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American association for the study of liver diseases. Hepatology. 2018;67(1):328–57.CrossRefPubMed Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American association for the study of liver diseases. Hepatology. 2018;67(1):328–57.CrossRefPubMed
4.
go back to reference Holterman AX, Guzman G, Fantuzzi G, Wang H, Aigner K, Browne A, et al. Nonalcoholic fatty liver disease in severely obese adolescent and adult patients. Obesity (Silver Spring). 2013;21(3):591–7.CrossRefPubMed Holterman AX, Guzman G, Fantuzzi G, Wang H, Aigner K, Browne A, et al. Nonalcoholic fatty liver disease in severely obese adolescent and adult patients. Obesity (Silver Spring). 2013;21(3):591–7.CrossRefPubMed
5.
go back to reference Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546–55.CrossRefPubMed Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546–55.CrossRefPubMed
6.
go back to reference Xia GL, Gong J, Wang JJ, Meng ZD, Jia ZY, Cao HL, et al. Efficacy of recombinant hepatitis B vaccine and low-dose hepatitis B immune globulin in preventing mother-infant transmission of hepatitis B virus infection. Zhonghua Liu Xing Bing Xue Za Zhi. 2003;24(5):362–5.PubMed Xia GL, Gong J, Wang JJ, Meng ZD, Jia ZY, Cao HL, et al. Efficacy of recombinant hepatitis B vaccine and low-dose hepatitis B immune globulin in preventing mother-infant transmission of hepatitis B virus infection. Zhonghua Liu Xing Bing Xue Za Zhi. 2003;24(5):362–5.PubMed
7.
go back to reference Liang X, Bi S, Yang W, Wang L, Cui G, Cui F, et al. Reprint of: epidemiological serosurvey of hepatitis B in China–declining HBV prevalence due to hepatitis B vaccination. Vaccine. 2013;31(Suppl 9):J21-28.CrossRefPubMed Liang X, Bi S, Yang W, Wang L, Cui G, Cui F, et al. Reprint of: epidemiological serosurvey of hepatitis B in China–declining HBV prevalence due to hepatitis B vaccination. Vaccine. 2013;31(Suppl 9):J21-28.CrossRefPubMed
9.
go back to reference Joo EJ, Chang Y, Yeom JS, Ryu S. Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease: a cohort study. Hepatology. 2017;65(3):828–35.CrossRefPubMed Joo EJ, Chang Y, Yeom JS, Ryu S. Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease: a cohort study. Hepatology. 2017;65(3):828–35.CrossRefPubMed
10.
go back to reference Cheng YL, Wang YJ, Kao WY, Chen PH, Huo TI, Huang YH, et al. Inverse association between hepatitis B virus infection and fatty liver disease: a large-scale study in populations seeking for check-up. PLoS ONE. 2013;8(8):e72049.CrossRefPubMedPubMedCentral Cheng YL, Wang YJ, Kao WY, Chen PH, Huo TI, Huang YH, et al. Inverse association between hepatitis B virus infection and fatty liver disease: a large-scale study in populations seeking for check-up. PLoS ONE. 2013;8(8):e72049.CrossRefPubMedPubMedCentral
11.
go back to reference Wang L, Wang Y, Liu S, Zhai X, Zhou G, Lu F, et al. Nonalcoholic fatty liver disease is associated with lower hepatitis B viral load and antiviral response in pediatric population. J Gastroenterol. 2019;54(12):1096–105.CrossRefPubMed Wang L, Wang Y, Liu S, Zhai X, Zhou G, Lu F, et al. Nonalcoholic fatty liver disease is associated with lower hepatitis B viral load and antiviral response in pediatric population. J Gastroenterol. 2019;54(12):1096–105.CrossRefPubMed
12.
go back to reference Seto WK, Hui RWH, Mak LY, Fung J, Cheung KS, Liu KSH, et al. Association between hepatic steatosis, measured by controlled attenuation parameter, and fibrosis burden in chronic hepatitis B. Clin Gastroenterol Hepatol. 2018;16(4):575-583.e572.CrossRefPubMed Seto WK, Hui RWH, Mak LY, Fung J, Cheung KS, Liu KSH, et al. Association between hepatic steatosis, measured by controlled attenuation parameter, and fibrosis burden in chronic hepatitis B. Clin Gastroenterol Hepatol. 2018;16(4):575-583.e572.CrossRefPubMed
13.
go back to reference Petta S, Camma C, Di Marco V, Macaluso FS, Maida M, Pizzolanti G, et al. Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection. Liver Int. 2011;31(4):507–15.CrossRefPubMed Petta S, Camma C, Di Marco V, Macaluso FS, Maida M, Pizzolanti G, et al. Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection. Liver Int. 2011;31(4):507–15.CrossRefPubMed
14.
go back to reference Peng D, Han Y, Ding H, Wei L. Hepatic steatosis in chronic hepatitis B patients is associated with metabolic factors more than viral factors. J Gastroenterol Hepatol. 2008;23(7 Pt 1):1082–8.CrossRefPubMed Peng D, Han Y, Ding H, Wei L. Hepatic steatosis in chronic hepatitis B patients is associated with metabolic factors more than viral factors. J Gastroenterol Hepatol. 2008;23(7 Pt 1):1082–8.CrossRefPubMed
15.
go back to reference Woods M. Peer reviewed: remote emissions testing hits the road. Environ Sci Technol. 1996;30(6):256a–7a.CrossRefPubMed Woods M. Peer reviewed: remote emissions testing hits the road. Environ Sci Technol. 1996;30(6):256a–7a.CrossRefPubMed
16.
go back to reference Yun JW, Cho YK, Park JH, Kim HJ, Park DI, Sohn CI, et al. Hepatic steatosis and fibrosis in young men with treatment-naive chronic hepatitis B. Liver Int. 2009;29(6):878–83.CrossRefPubMed Yun JW, Cho YK, Park JH, Kim HJ, Park DI, Sohn CI, et al. Hepatic steatosis and fibrosis in young men with treatment-naive chronic hepatitis B. Liver Int. 2009;29(6):878–83.CrossRefPubMed
17.
go back to reference Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–99.CrossRefPubMed Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–99.CrossRefPubMed
18.
go back to reference Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007;8(5):299–306.CrossRefPubMed Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007;8(5):299–306.CrossRefPubMed
19.
go back to reference Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR cooperative study group. Hepatology. 1996;24(2):289–93.CrossRefPubMed Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR cooperative study group. Hepatology. 1996;24(2):289–93.CrossRefPubMed
20.
go back to reference Machado MV, Oliveira AG, Cortez-Pinto H. Hepatic steatosis in hepatitis B virus infected patients: meta-analysis of risk factors and comparison with hepatitis C infected patients. J Gastroenterol Hepatol. 2011;26(9):1361–7.CrossRefPubMed Machado MV, Oliveira AG, Cortez-Pinto H. Hepatic steatosis in hepatitis B virus infected patients: meta-analysis of risk factors and comparison with hepatitis C infected patients. J Gastroenterol Hepatol. 2011;26(9):1361–7.CrossRefPubMed
21.
go back to reference Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the expert committee on NAFLD (ECON) and the North American society of pediatric gastroenterology, hepatology and nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017;64(2):319–34.CrossRefPubMedPubMedCentral Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the expert committee on NAFLD (ECON) and the North American society of pediatric gastroenterology, hepatology and nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017;64(2):319–34.CrossRefPubMedPubMedCentral
22.
go back to reference Yan Y, Allweiss L, Yang D, Kang J, Wang J, Qian X, et al. Down-regulation of cell membrane localized NTCP expression in proliferating hepatocytes prevents hepatitis B virus infection. Emerg Microbes Infect. 2019;8(1):879–94.CrossRefPubMedPubMedCentral Yan Y, Allweiss L, Yang D, Kang J, Wang J, Qian X, et al. Down-regulation of cell membrane localized NTCP expression in proliferating hepatocytes prevents hepatitis B virus infection. Emerg Microbes Infect. 2019;8(1):879–94.CrossRefPubMedPubMedCentral
23.
go back to reference Altlparmak E, Koklu S, Yalinkilic M, Yuksel O, Cicek B, Kayacetin E, et al. Viral and host causes of fatty liver in chronic hepatitis B. World J Gastroenterol. 2005;11(20):3056–9.CrossRefPubMedPubMedCentral Altlparmak E, Koklu S, Yalinkilic M, Yuksel O, Cicek B, Kayacetin E, et al. Viral and host causes of fatty liver in chronic hepatitis B. World J Gastroenterol. 2005;11(20):3056–9.CrossRefPubMedPubMedCentral
24.
go back to reference Shi JP, Fan JG, Wu R, Gao XQ, Zhang L, Wang H, et al. Prevalence and risk factors of hepatic steatosis and its impact on liver injury in Chinese patients with chronic hepatitis B infection. J Gastroenterol Hepatol. 2008;23(9):1419–25.CrossRefPubMed Shi JP, Fan JG, Wu R, Gao XQ, Zhang L, Wang H, et al. Prevalence and risk factors of hepatic steatosis and its impact on liver injury in Chinese patients with chronic hepatitis B infection. J Gastroenterol Hepatol. 2008;23(9):1419–25.CrossRefPubMed
25.
go back to reference Poortahmasebi V, Alavian SM, Keyvani H, Norouzi M, Mahmoodi M, Jazayeri SM. Hepatic steatosis: prevalence and host/viral risk factors in Iranian patients with chronic hepatitis B infection. Asian Pac J Cancer Prev. 2014;15(9):3879–84.CrossRefPubMed Poortahmasebi V, Alavian SM, Keyvani H, Norouzi M, Mahmoodi M, Jazayeri SM. Hepatic steatosis: prevalence and host/viral risk factors in Iranian patients with chronic hepatitis B infection. Asian Pac J Cancer Prev. 2014;15(9):3879–84.CrossRefPubMed
26.
go back to reference Bondini S, Kallman J, Wheeler A, Prakash S, Gramlich T, Jondle DM, et al. Impact of non-alcoholic fatty liver disease on chronic hepatitis B. Liver Int. 2007;27(5):607–11.CrossRefPubMed Bondini S, Kallman J, Wheeler A, Prakash S, Gramlich T, Jondle DM, et al. Impact of non-alcoholic fatty liver disease on chronic hepatitis B. Liver Int. 2007;27(5):607–11.CrossRefPubMed
27.
go back to reference Thomopoulos KC, Arvaniti V, Tsamantas AC, Dimitropoulou D, Gogos CA, Siagris D, et al. Prevalence of liver steatosis in patients with chronic hepatitis B: a study of associated factors and of relationship with fibrosis. Eur J Gastroenterol Hepatol. 2006;18(3):233–7.CrossRefPubMed Thomopoulos KC, Arvaniti V, Tsamantas AC, Dimitropoulou D, Gogos CA, Siagris D, et al. Prevalence of liver steatosis in patients with chronic hepatitis B: a study of associated factors and of relationship with fibrosis. Eur J Gastroenterol Hepatol. 2006;18(3):233–7.CrossRefPubMed
Metadata
Title
Association of chronic hepatitis B infection with hepatic steatosis and injury in nonalcoholic fatty liver disease children
Authors
Lu Wang
Chang Lu
Yuncong Zhang
Qingsheng Liang
Jie Zhang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2024
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-023-03103-9

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