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

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). Aims: To investigate the prevalence and determinants of steatosis and insulin resistance (IR) in CHB and its consequences on liver injury compared with CHC and NAFLD. Methods: Patients with CHB (N = 110), CHC (N = 111) and NAFLD (N = 136) were evaluated by biomarkers of steatosis (SteatoTest N 0.38 as a surrogate for steatosis N5%), IR (HOMA-IR > 2.7 as a surrogate for IR) and fibrosis (FibroTest > 0.48 as a surrogate for significant fibrosis, >= F2). Results: HOMA-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 N5% 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/m(2) vs. 24 +/- 4 kg/m(2), p < 0.001), waist circumference (96 +/- 14 cmvs. 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. Conclusions: Steatosis 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. (C) 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.