Top

Current Hepatology Reports

Published in:

01-06-2017 | Hepatitis B (J Lim, Section Editor)

Impact of Non-alcoholic Fatty Liver Disease on Chronic Hepatitis B Infection

Authors: Anthony W.H. Chan, Grace L.H. Wong, Vincent W.S. Wong

Published in: Current Hepatology Reports | Issue 2/2017

Abstract

Purpose of review

Both chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are frequent liver diseases with substantial morbidity and mortality. How often do these two diseases occur together? Does hepatitis B virus protect or promote concurrent fatty liver? How does concurrent fatty liver influence the clinical outcomes of CHB? We summarized the latest evidence to tackle all these clinically significant questions.

Recent findings

Concurrent fatty liver in CHB without significant alcohol intake is a common and increasingly alarming problem. Patients with CHB have a lower chance of fatty liver than the general population, but the underlying mechanism remains to be further explored. Clinical impacts of concurrent fatty liver among CHB patients, in terms of treatment response, fibrosis and cirrhosis progression, liver cancer risk, and mortality, are still debatable.

Summary

Concurrent fatty liver in CHB is a common and clinically relevant condition.

Chan SL, Wong VW, Qin S, Chan HL. Infection and cancer: the case of hepatitis B. J Clin Oncol. 2016;34(1):83–90. doi:10.1200/JCO.2015.61.5724.CrossRefPubMed

European Association for the Study of the Liver, European Organisation For Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43. doi:10.1016/j.jhep.2011.12.001.CrossRef

Farrell GC, Wong VW, Chitturi S. NAFLD in Asia—as common and important as in the West. Nat Rev Gastroenterol Hepatol. 2013;10(5):307–18. doi:10.1038/nrgastro.2013.34.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. doi:10.1016/S0140-6736(15)61412-X.CrossRefPubMed

Yuen MF, Hou JL, Chutaputti A. Asia Pacific working party on prevention of hepatocellular C. Hepatocellular carcinoma in the Asia pacific region. J Gastroenterol Hepatol. 2009;24(3):346–53. doi:10.1111/j.1440-1746.2009.05784.x.CrossRefPubMed

Trepo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet. 2014;384(9959):2053–63. doi:10.1016/S0140-6736(14)60220-8.CrossRefPubMed

Mortality GBD. Causes of death C. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459–544. doi:10.1016/S0140-6736(16)31012-1.CrossRef

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. doi:10.1002/hep.28431.CrossRefPubMed

Younossi ZM, Otgonsuren M, Henry L, Venkatesan C, Mishra A, Erario M, et al. Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009. Hepatology. 2015;62(6):1723–30. doi:10.1002/hep.28123.CrossRefPubMed

10.

Ascha MS, Hanouneh IA, Lopez R, Tamimi TA, Feldstein AF, Zein NN. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology. 2010;51(6):1972–8. doi:10.1002/hep.23527.CrossRefPubMed

11.

Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–55. doi:10.1053/j.gastro.2014.11.039.CrossRefPubMed

12.

Lefkowitch JH, Schiff ER, Davis GL, Perrillo RP, Lindsay K, Bodenheimer Jr HC, et al. Pathological diagnosis of chronic hepatitis C: a multicenter comparative study with chronic hepatitis B. The Hepatitis Interventional Therapy Group Gastroenterology. 1993;104(2):595–603.PubMed

13.

Asselah T, Rubbia-Brandt L, Marcellin P, Negro F. Steatosis in chronic hepatitis C: why does it really matter? Gut. 2006;55(1):123–30. doi:10.1136/gut.2005.069757.CrossRefPubMedPubMedCentral

14.

Negro F. Facts and fictions of HCV and comorbidities: steatosis, diabetes mellitus, and cardiovascular diseases. J Hepatol. 2014;61(1 Suppl):S69–78. doi:10.1016/j.jhep.2014.08.003.CrossRefPubMed

15.

Wong VW, Wong GL, Yu J, Choi PC, Chan AW, Chan HY, et al. Interaction of adipokines and hepatitis B virus on histological liver injury in the Chinese. Am J Gastroenterol. 2010;105(1):132–8. doi:10.1038/ajg.2009.560.CrossRefPubMed

16.

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. doi:10.1111/j.1440-1746.2011.06801.x.PubMed

17.

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

18.

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

19.

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. doi:10.1111/j.1478-3231.2007.01482.x.CrossRefPubMed

20.

Cindoruk M, Karakan T, Unal S. Hepatic steatosis has no impact on the outcome of treatment in patients with chronic hepatitis B infection. J Clin Gastroenterol. 2007;41(5):513–7. doi:10.1097/01.mcg.0000225586.78330.60.CrossRefPubMed

21.

Tsochatzis E, Papatheodoridis GV, Manesis EK, Chrysanthos N, Kafiri G, Archimandritis AJ. Hepatic steatosis in chronic hepatitis B develops due to host metabolic factors: a comparative approach with genotype 1 chronic hepatitis C. Dig Liver Dis. 2007;39(10):936–42. doi:10.1016/j.dld.2007.07.151.CrossRefPubMed

22.

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. doi:10.1111/j.1440-1746.2008.05478.x.CrossRefPubMed

23.

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. doi:10.1111/j.1440-1746.2008.05531.x.CrossRefPubMed

24.

Minakari M, Molaei M, Shalmani HM, Mohammad Alizadeh AH, Jazi AH, Naderi N, et al. Liver steatosis in patients with chronic hepatitis B infection: host and viral risk factors. Eur J Gastroenterol Hepatol. 2009;21(5):512–6. doi:10.1097/MEG.0b013e328326792e.CrossRefPubMed

25.

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. doi:10.1111/j.1478-3231.2009.01976.x.CrossRefPubMed

26.

Zheng RD, Xu CR, Jiang L, Dou AX, Zhou K, Lu LG. Predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B patients and their diagnostic values in hepatic fibrosis. Int J Med Sci. 2010;7(5):272–7.CrossRefPubMedPubMedCentral

27.

Rastogi A, Sakhuja P, Kumar A, Hissar S, Jain A, Gondal R, et al. Steatosis in chronic hepatitis B: prevalence and correlation with biochemical, histologic, viral, and metabolic parameters. Indian J Pathol Microbiol. 2011;54(3):454–9. doi:10.4103/0377-4929.85074.CrossRefPubMed

28.

Wang MM, Wang GS, Shen F, Chen GY, Pan Q, Fan JG. Hepatic steatosis is highly prevalent in hepatitis B patients and negatively associated with virological factors. Dig Dis Sci. 2014;59(10):2571–9. doi:10.1007/s10620-014-3180-9.CrossRefPubMed

29.

• Chan AW, Wong GL, Chan HY, Tong JH, Yu YH, Choi PC et al. Concurrent fatty liver increases risk of hepatocellular carcinoma among patients with chronic hepatitis B. J Gastroenterol Hepatol. 2017;32(3):667–76. doi:10.1111/jgh.13536. Concurrent fatty liver is common in chronic hepatitis B patients and an independent risk factor potentiating HBV-associated HCC development by 7.3-fold. The risk of HBV-related HCC is increased by APOC3 gene polymorphism by 3.9-fold.

30.

• Charatcharoenwitthaya P, Pongpaibul A, Kaosombatwattana U, Bhanthumkomol P, Bandidniyamanon W, Pausawasdi N et al. The prevalence of steatohepatitis in chronic hepatitis B patients and its impact on disease severity and treatment response. Liver Int. 2017;37(4):542–51. doi:10.1111/liv.13271. Concurrent steatohepatitis is common in chronic hepatitis B patients and associated with metabolic syndrome but not viral factor. Steatohepatitis is related to the severity of liver fibrosis but does not affect response to antiviral therapy.

31.

Zhang Z, Wang G, Kang K, Wu G, Wang P. Diagnostic accuracy and clinical utility of a new noninvasive index for hepatic steatosis in patients with hepatitis B virus infection. Sci Rep. 2016;6:32875. doi:10.1038/srep32875.CrossRefPubMedPubMedCentral

32.

Wang CC, Hsu CS, Liu CJ, Kao JH, Chen DS. Association of chronic hepatitis B virus infection with insulin resistance and hepatic steatosis. J Gastroenterol Hepatol. 2008;23(5):779–82. doi:10.1111/j.1440-1746.2007.05216.x.CrossRefPubMed

33.

Wong VW, Wong GL, Chu WC, Chim AM, Ong A, Yeung DK, et al. Hepatitis B virus infection and fatty liver in the general population. J Hepatol. 2012;56(3):533–40. doi:10.1016/j.jhep.2011.09.013.CrossRefPubMed

34.

Chu CM, Lin DY, Liaw YF. Clinical and virological characteristics post HBsAg seroclearance in hepatitis B virus carriers with hepatic steatosis versus those without. Dig Dis Sci. 2013;58(1):275–81. doi:10.1007/s10620-012-2343-9.CrossRefPubMed

35.

Pais R, Rusu E, Zilisteanu D, Circiumaru A, Micu L, Voiculescu M, et al. Prevalence of steatosis and insulin resistance in patients with chronic hepatitis B compared with chronic hepatitis C and non-alcoholic fatty liver disease. Eur J Intern Med. 2015;26(1):30–6. doi:10.1016/j.ejim.2014.12.001.CrossRefPubMed

36.

Hwang SJ, Lee SD. Hepatic steatosis and hepatitis C: still unhappy bedfellows? J Gastroenterol Hepatol. 2011;26(Suppl 1):96–101. doi:10.1111/j.1440-1746.2010.06542.x.CrossRefPubMed

37.

Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23. doi:10.1002/hep.25762.CrossRefPubMed

38.

European Association for the Study of the Liver. Electronic address eee, European Association for the Study of D, European Association for the Study of O. EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388–402. doi:10.1016/j.jhep.2015.11.004.CrossRef

39.

Hsu HC, Lai MY, Su IJ, Chen DS, Chang MH, Yang PM, et al. Correlation of hepatocyte HBsAg expression with virus replication and liver pathology. Hepatology. 1988;8(4):749–54.CrossRefPubMed

40.

Ramakrishna B, Mukhopadhya A, Kurian G. Correlation of hepatocyte expression of hepatitis B viral antigens with histological activity and viral titer in chronic hepatitis B virus infection: an immunohistochemical study. J Gastroenterol Hepatol. 2008;23(11):1734–8. doi:10.1111/j.1440-1746.2008.05416.x.CrossRefPubMed

41.

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. doi:10.1371/journal.pone.0072049.CrossRefPubMedPubMedCentral

42.

Jan CF, Chen CJ, Chiu YH, Chen LS, Wu HM, Huang CC, et al. A population-based study investigating the association between metabolic syndrome and hepatitis B/C infection (Keelung Community-Based Integrated Screening Study No. 10). Int J Obes. 2006;30(5):794–9. doi:10.1038/sj.ijo.0803204.CrossRef

43.

Luo B, Wang Y, Wang K. Association of metabolic syndrome and hepatitis B infection in a Chinese population. Clin Chim Acta. 2007;380(1–2):238–40. doi:10.1016/j.cca.2007.01.012.CrossRefPubMed

44.

Jinjuvadia R, Liangpunsakul S. Association between metabolic syndrome and its individual components with viral hepatitis B. Am J Med Sci. 2014;347(1):23–7. doi:10.1097/MAJ.0b013e31828b25a5.CrossRefPubMed

45.

Hajjou M, Norel R, Carver R, Marion P, Cullen J, Rogler LE, et al. cDNA microarray analysis of HBV transgenic mouse liver identifies genes in lipid biosynthetic and growth control pathways affected by HBV. J Med Virol. 2005;77(1):57–65. doi:10.1002/jmv.20427.CrossRefPubMed

46.

Yang F, Yan S, He Y, Wang F, Song S, Guo Y, et al. Expression of hepatitis B virus proteins in transgenic mice alters lipid metabolism and induces oxidative stress in the liver. J Hepatol. 2008;48(1):12–9. doi:10.1016/j.jhep.2007.06.021.CrossRefPubMed

47.

Kim KH, Shin HJ, Kim K, Choi HM, Rhee SH, Moon HB, et al. Hepatitis B virus X protein induces hepatic steatosis via transcriptional activation of SREBP1 and PPARgamma. Gastroenterology. 2007;132(5):1955–67. doi:10.1053/j.gastro.2007.03.039.CrossRefPubMed

48.

Kim K, Kim KH, Kim HH, Cheong J. Hepatitis B virus X protein induces lipogenic transcription factor SREBP1 and fatty acid synthase through the activation of nuclear receptor LXRalpha. Biochem J. 2008;416(2):219–30. doi:10.1042/BJ20081336.CrossRefPubMed

49.

Na TY, Shin YK, Roh KJ, Kang SA, Hong I, Oh SJ, et al. Liver X receptor mediates hepatitis B virus X protein-induced lipogenesis in hepatitis B virus-associated hepatocellular carcinoma. Hepatology. 2009;49(4):1122–31. doi:10.1002/hep.22740.CrossRefPubMed

50.

Kang SK, Chung TW, Lee JY, Lee YC, Morton RE, Kim CH. The hepatitis B virus X protein inhibits secretion of apolipoprotein B by enhancing the expression of N-acetylglucosaminyltransferase III. J Biol Chem. 2004;279(27):28106–12. doi:10.1074/jbc.M403176200.CrossRefPubMed

51.

Wu YL, Peng XE, Zhu YB, Yan XL, Chen WN, Lin X. Hepatitis B virus X protein induces hepatic steatosis by enhancing the expression of liver fatty acid binding protein. J Virol. 2015;90(4):1729–40. doi:10.1128/JVI.02604-15.CrossRefPubMed

52.

Charlton M, Viker K, Krishnan A, Sanderson S, Veldt B, Kaalsbeek AJ, et al. Differential expression of lumican and fatty acid binding protein-1: new insights into the histologic spectrum of nonalcoholic fatty liver disease. Hepatology. 2009;49(4):1375–84. doi:10.1002/hep.22927.CrossRefPubMedPubMedCentral

53.

Wang MD, Wu H, Huang S, Zhang HL, Qin CJ, Zhao LH, et al. HBx regulates fatty acid oxidation to promote hepatocellular carcinoma survival during metabolic stress. Oncotarget. 2016;7(6):6711–26. doi:10.18632/oncotarget.6817.PubMedPubMedCentral

54.

Yoon S, Jung J, Kim T, Park S, Chwae YJ, Shin HJ, et al. Adiponectin, a downstream target gene of peroxisome proliferator-activated receptor gamma, controls hepatitis B virus replication. Virology. 2011;409(2):290–8. doi:10.1016/j.virol.2010.10.024.CrossRefPubMed

55.

Ates F, Yalniz M, Alan S. Impact of liver steatosis on response to pegylated interferon therapy in patients with chronic hepatitis B. World J Gastroenterol. 2011;17(40):4517–22. doi:10.3748/wjg.v17.i40.4517.CrossRefPubMedPubMedCentral

56.

Gong L, Liu J, Wang J, Lou GQ, Shi JP. Hepatic steatosis as a predictive factor of antiviral effect of Pegylated interferon therapy in patients with hepatitis B. Transplant Proc. 2015;47(10):2886–91. doi:10.1016/j.transproceed.2015.10.023.CrossRefPubMed

57.

Jin X, Chen YP, Yang YD, Li YM, Zheng L, Xu CQ. Association between hepatic steatosis and entecavir treatment failure in Chinese patients with chronic hepatitis B. PLoS One. 2012;7(3):e34198. doi:10.1371/journal.pone.0034198.CrossRefPubMedPubMedCentral

58.

• Hsiang JC, Wong GL, Chan HL, Chan AW, Chim AM, Wong VW. Metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B. Aliment Pharmacol Ther. 2014;40(6):716–26. doi:10.1111/apt.12874. Concurrent pre-metabolic syndrome or metabolic syndrome delayed HBeAg seroclearance among chronic hepatitis B patients.

59.

• Ceylan B, Arslan F, Batirel A, Fincanci M, Yardimci C, Fersan E, et al. Impact of fatty liver on hepatitis B virus replication and virologic response to tenofovir and entecavir. Turk J Gastroenterol. 2016;27(1):42–6. doi:10.5152/tjg.2015.150348. Concurrent NAFLD decreases viral replication in chronic hepatitis B patients but does not have impact on the virologic response to entecavir and tenofovir treatment.

60.

Buit M, Washington MK, Gane E, Aguilar Schall R, Bornstein JD, Subramanian M, et al. Hepatic steatosis does not predict regression of liver cirrhosis in chronic hepatitis B (CHB) patients treated with tenofovir disoproxil fumarate (TDF). J Hepatol. 2014;60(Suppl):S294–S5. doi:10.1016/S0168-8278(14)60839-4.CrossRef

61.

• Wong GL, Chan HL, Yu Z, Chan AW, Choi PC, Chim AM, et al. Coincidental metabolic syndrome increases the risk of liver fibrosis progression in patients with chronic hepatitis B—a prospective cohort study with paired transient elastography examinations. Aliment Pharmacol Ther. 2014;39(8):883–93. doi:10.1111/apt.12658. Concurrent metabolic syndrome increases the risk of liver fibrosis progression in patients with chronic hepatitis B infection, independent of viral load and hepatitis activity.

62.

• Mena A, Pedreira JD, Castro A, Lopez S, Vazquez P, Poveda E. Metabolic syndrome association with fibrosis development in chronic hepatitis B virus inactive carriers. J Gastroenterol Hepatol. 2014;29(1):173–8. doi:10.1111/jgh.12432. Components of metabolic syndrome increases the risk of fibrosis development in chronic hepatitis B inactive carriers. Significant fibrosis is uncommon among these patients without concurrent metabolic syndrome.

63.

Fung J, Lai CL, But D, Wong D, Cheung TK, Yuen MF. Prevalence of fibrosis and cirrhosis in chronic hepatitis B: implications for treatment and management. Am J Gastroenterol. 2008;103(6):1421–6. doi:10.1111/j.1572-0241.2007.01751.x.CrossRefPubMed

64.

Wong GL, Wong VW, Choi PC, Chan AW, Chim AM, Yiu KK, et al. Clinical factors associated with liver stiffness in hepatitis B e antigen-positive chronic hepatitis B patients. Clin Gastroenterol Hepatol. 2009;7(2):227–33. doi:10.1016/j.cgh.2008.10.023.CrossRefPubMed

65.

Hsiang J, Wong GL, Chan HL, Wong VW. Editorial: metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B—authors' reply. Aliment Pharmacol Ther. 2014;40(8):983. doi:10.1111/apt.12932.CrossRefPubMed

66.

Wong GL, Wong VW, Choi PC, Chan AW, Chim AM, Yiu KK, et al. Metabolic syndrome increases the risk of liver cirrhosis in chronic hepatitis B. Gut. 2009;58(1):111–7. doi:10.1136/gut.2008.157735.CrossRefPubMed

67.

Huang YW, Wang TC, Lin SC, Chang HY, Chen DS, Hu JT, et al. Increased risk of cirrhosis and its decompensation in chronic hepatitis B patients with newly diagnosed diabetes: a nationwide cohort study. Clin Infect Dis. 2013;57(12):1695–702. doi:10.1093/cid/cit603.CrossRefPubMed

68.

Yu MW, Shih WL, Lin CL, Liu CJ, Jian JW, Tsai KS, et al. Body-mass index and progression of hepatitis B: a population-based cohort study in men. J Clin Oncol. 2008;26(34):5576–82. doi:10.1200/JCO.2008.16.1075.CrossRefPubMed

69.

Chen CL, Yang HI, Yang WS, Liu CJ, Chen PJ, You SL, et al. Metabolic factors and risk of hepatocellular carcinoma by chronic hepatitis B/C infection: a follow-up study in Taiwan. Gastroenterology. 2008;135(1):111–21. doi:10.1053/j.gastro.2008.03.073.CrossRefPubMed

70.

• Fu SC, Huang YW, Wang TC, Hu JT, Chen DS, Yang SS. Increased risk of hepatocellular carcinoma in chronic hepatitis B patients with new onset diabetes: a nationwide cohort study. Aliment Pharmacol Ther. 2015;41(11):1200–9. doi:10.1111/apt.13191. In a cohort of 14523 Taiwanese patients with chronic hepatitis B, new-onset diabetes mellitus independently increases HCC risk after adjustment of age, gender, cirrhosis, antiviral treatment, obesity, hyperlipidemia, and statin treatment.

71.

Welzel TM, Graubard BI, Zeuzem S, El-Serag HB, Davila JA, McGlynn KA. Metabolic syndrome increases the risk of primary liver cancer in the United States: a study in the SEER-Medicare database. Hepatology. 2011;54(2):463–71. doi:10.1002/hep.24397.CrossRefPubMedPubMedCentral

72.

• Cheng JY, Wong VW, Tse YK, Chim AM, Chan HL, Wong GL. Metabolic syndrome increases cardiovascular events but not hepatic events and death in patients with chronic hepatitis B. Hepatology. 2016;64(5):1507–17. doi:10.1002/hep.28778. In a prospective cohort of 1466 chronic hepatitis B patients, metabolic syndrome increases the risk of cardiovascular events but not hepatic events and death. Liver stiffness measurement is the important risk factor of hepatic events and death in chronic hepatitis B patients.

73.

Brouwer WP, van der Meer AJ, Boonstra A, Pas SD, de Knegt RJ, de Man RA, et al. The impact of PNPLA3 (rs738409 C>G) polymorphisms on liver histology and long-term clinical outcome in chronic hepatitis B patients. Liver Int. 2015;35(2):438–47. doi:10.1111/liv.12695.CrossRefPubMed

74.

Stepanova M, Rafiq N, Younossi ZM. Components of metabolic syndrome are independent predictors of mortality in patients with chronic liver disease: a population-based study. Gut. 2010;59(10):1410–5. doi:10.1136/gut.2010.213553.CrossRefPubMed

Title: Impact of Non-alcoholic Fatty Liver Disease on Chronic Hepatitis B Infection
Authors: Anthony W.H. Chan
Grace L.H. Wong
Vincent W.S. Wong
Publication date: 01-06-2017
Publisher: Springer US
Published in: Current Hepatology Reports / Issue 2/2017
Electronic ISSN: 2195-9595
DOI: https://doi.org/10.1007/s11901-017-0340-3

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of Non-alcoholic Fatty Liver Disease on Chronic Hepatitis B Infection

Abstract

Purpose of review

Recent findings

Summary

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of review

Recent findings

Summary

Please log in to get access to this content

Other articles of this Issue 2/2017

Ethnic Disparities in Chronic Hepatitis B Infection: African Americans and Hispanic Americans

Multidisciplinary Team Management of Patients with Hepatocellular Carcinoma

Management of Chronic Hepatitis B in Children

Portal Vein Thrombosis and Cirrhosis: The Role of Anticoagulation

Autoimmune Hepatitis: When Is It Safe to Stop Therapy, or Withhold Therapy Altogether?

Why Doesn’t Primary Biliary Cholangitis Respond to Immunosuppressive Medications?

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page