Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and the Risk of Cirrhosis in Patients with Chronic Hepatitis B—A Retrospective Cohort Study

Abstract

Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is a novel proposed concept that is being recognized worldwide. Both chronic hepatitis B (CHB) and MAFLD have been independently attributed to an increased risk of disease development to cirrhosis. However, it is still unclear whether MAFLD is associated with an increased risk of cirrhosis in CHB patients. Aim This study aimed to analyze the impact of MAFLD on the risk of cirrhosis in CHB patients. Methods In this retrospective cohort study, consecutive CHB patients with or without MAFLD were enrolled from January 1st, 2007, to May 1st, 2020, in Guangdong Provincial Hospital of Chinese Medicine. Inverse probability treatment weighting (IPTW) was performed to balance the covariates across groups. The weighted Kaplan–Meier analysis and Cox regression analysis were used to compare both groups for the risk of cirrhosis. Results A total of 1223 CHB patients were included in this study during the median follow-up of 5.25 years; of these patients, 355 were CHB-MAFLD patients. After IPTW, the weighted Kaplan–Meier analysis showed that the weighted cumulative incidence of cirrhosis was significantly higher in patients with MAFLD than that in patients without MAFLD (12.6% versus 7.1%, P=0.015). In the weighted multivariate Cox analysis, coexisting MAFLD was related to an increased risk of cirrhosis [adjusted weighted hazard ratio (HR) 1.790; P =0.020]. Age (>40 years, adjusted weighted HR, 1.950; P=0.015), diabetes mellitus (adjusted weighted HR, 1.883; P=0.041), non-antiviral treatment (adjusted weighted HR, 2.037; P=0.013), and baseline serum HBV DNA levels (>2.4 log 10 IU/mL, adjusted weighted HR, 1.756; P=0.045) were significant risk factors for cirrhosis. Conclusion We found that MAFLD was associated with a higher risk of cirrhosis in CHB patients.

The impact of concomitant metabolic dysfunction-associated fatty liver disease on adverse outcomes in patients with hepatitis B cirrhosis: a propensity score matching study

“…Compared with those without MAFLD, patients with MAFLD had higher hemoglobin [127 (108-144. (6)(7)(8)(9)(10)(11)(12)(13)(14) vs. 8.3 (5.7-12.5), P = 0.016] except that there were significant differences in the components of diagnostic MAFLD. In terms of liver-related complications, non-MAFLD patients were more likely to be accompanied by history of variceal hemorrhage [40 (21.6) vs. 88 (34.6), P = 0.005].…”

“…The definition of MAFLD allows for the incorporation of multiple causes of liver disease, this uniqueness of the definition of MAFLD allowed us to investigate the interaction between CHB and MAFLD, especially in the context of the high incidence of CHB and fatty liver in the Asian region [12]. In fact, a previous study has shown that the presence of MAFLD in patients with CHB was significantly associated with an increased risk of liver-related clinical events and death, and MAFLD also increased the probability of developing cirrhosis in patients with CHB [7,13]. It was acknowledged that NAFLD was a liver component of a series of diseases related to metabolic dysfunction and could progress to liver fibrosis, cirrhosis and portal hypertension, which significantly increased liver-related mortality and the risk of complications such as ascites, hepatic encephalopathy, variceal bleeding [14][15][16].…”

Prevalence of metabolic syndrome among patients with hepatocellular carcinoma of different etiologies: a retrospective study

“…Given the association between MAFLD and higher risk of cirrhosis observed in a retrospective cohort study from China [ 26 ], and given reports that a growing percentage of cirrhosis cases in coming decades will occur in individuals with non-alcoholic fatty liver disease [ 27 ], we recommend careful assessment of comorbidities and liver function in HCC patients before hepatectomy. This may be particularly important for patients chronically infected with hepatitis virus, since those patients in our study showed higher prevalence of cirrhosis, portal hypertension, and ascites than patients with MAFLD but without chronic infection.…”

ADAR1 Inhibits HBV DNA Replication via Regulating miR-122-5p in Palmitic Acid Treated HepG2.2.15 Cells

“…This subsequently enhances HBV replication by bile-acid-mediated repression of some interferon-stimulated genes, [24][25][26] and can increase the risk of cirrhosis in patients with CHB. 27 The discrepancy may reflect the complexity of HBV infection combined with NAFLD in clinical practice and basic research. Therefore, more studies are needed to further explore the effect of HS on HBV infection.…”