Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives

Huang, Shang‐Chin; Liu, Chun‐Jen

doi:10.3350/cmh.2022.0422

Cited by 43 publications

(33 citation statements)

References 72 publications

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“…In patients with combined CHB and fatty liver, there are controversial results, with a few reports suggesting that fatty liver was associated with a higher probability of HCC, 20,21 and others reporting the contrary, that fatty liver was associated with a lower risk of HCC. 6,[22][23][24] These discordant results may be attributed to the complex relationships between hepatic steatosis and hepatitis B virus (HBV) infection, such as the direct suppression of HBV viral activity by steatosis, 25 which may have affected the outcome, and the inclusion of heterogeneous CHB patients with or without antiviral therapy or different adherence to antiviral drugs. However, in an analysis of only fully virologically suppressed patients but with advanced chronic liver disease (≥10 kPa), a lower degree of liver fat content was shown to be significantly associated with a higher risk of HCC, which corresponds to the results shown in our study.…”

Section: In Context With Current Literaturementioning

confidence: 99%

Low liver fat in non‐alcoholic steatohepatitis‐related significant fibrosis and cirrhosis is associated with hepatocellular carcinoma, decompensation and mortality

Lee,

Huang,

Bettencourt

et al. 2023

Aliment Pharmacol Ther

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SummaryBackgroundProgression to cirrhosis in non‐alcoholic steatohepatitis (NASH) is associated with a decrease in liver fat. However, the prognostic significance of liver fat content in NASH‐related significant fibrosis and cirrhosis is unclear.AimTo investigate the risk of decompensation, hepatocellular carcinoma (HCC) and mortality stratified by liver fat content in NASH‐related significant fibrosis and cirrhosis.MethodsIn this meta‐analysis of individual participant data, 456 patients with both magnetic resonance elastography (MRE) and MRI‐derived protein density fat fraction (MRI‐PDFF) were enrolled, and 296 patients with longitudinal follow‐up were analysed. MRE combined with fibrosis‐4 (MEFIB‐index), and MRI‐PDFF were used to measure liver fibrosis and fat, respectively. MEFIB‐negative, MEFIB‐positive+ MRI‐PDFF ≥5% and MEFIB‐positive+ MRI‐PDFF <5% were defined as no significant liver fibrosis, NASH with significant fibrosis and higher liver fat content, and NASH with significant fibrosis and low liver fat content groups, respectively. The primary outcome was hepatic decompensation, HCC and death.ResultsThe rates of decompensation, HCC and mortality were highest in the NASH with significant fibrosis and low liver fat group (33%, 17% and 17%, respectively), followed by the NASH with significant fibrosis and higher liver fat group (18%, 13% and 13% respectively), and lowest in the no significant fibrosis (MEFIB‐negative) group (0%, 1% and 2% respectively). In multivariable‐adjusted analysis, low liver fat content was strongly associated (HR = 42.2 [95% CI: 7.5–235.5, p < 0.0001]) with HCC, decompensation and death. Sensitivity analyses for patients with cirrhosis (MRE ≥5 kPa) determined consistent findings.ConclusionsLow liver fat content in patients with burnt‐out NASH‐related significant fibrosis and cirrhosis is associated with an increase in hepatic decompensation, HCC and mortality.

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Section: In Context With Current Literaturementioning

confidence: 99%

Low liver fat in non‐alcoholic steatohepatitis‐related significant fibrosis and cirrhosis is associated with hepatocellular carcinoma, decompensation and mortality

Lee,

Huang,

Bettencourt

et al. 2023

Aliment Pharmacol Ther

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“…Thorough investigations are essential to validate and clarify the optimal therapeutic choice in this specific patient population. 19,40,41 Furthermore, a multidisciplinary approach, involving physicians from diverse specialties and dietitians, should be adopted in the patient care plan to optimize glycemic control and mitigate adverse outcomes.…”

Section: Essential Criterionmentioning

confidence: 99%

The interplay between chronic hepatitis B and diabetes mellitus: A narrative and concise review

Huang,

Kao

2023

The Kaohsiung J of Med Scie

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Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder among individuals with chronic hepatitis B (CHB), contributing to additional adverse impacts on both hepatic and extrahepatic systems. Existing evidence suggests a potential positive association between CHB and the development of insulin resistance and T2DM. The presence of T2DM in CHB patients is associated with an increased risk of liver fibrosis, cirrhosis, decompensation, and hepatocellular carcinoma (HCC) occurrence. Moreover, it elevates the risk of non‐liver cancers and all‐cause mortality in this population. T2DM also serves as the key element in metabolic dysfunction‐associated steatotic liver disease, which is prevalent in the CHB population. Although specific guidelines for managing T2DM in CHB patients have not been proposed, some studies indicated that intensive glycemic control may benefit the prognosis of these patients. Additionally, specific antidiabetic agents, such as metformin and thiazolidinediones, promise to reduce HCC risk. However, unresolved questions, including the optimal glycemic control target and the selection of antidiabetic agents for CHB patients, remain and thus warrant further investigations through well‐designed prospective trials. Implementing a standardized protocol encompassing regular monitoring, risk stratification, and early intervention using a multidisciplinary framework may improve the outcomes of diabetic CHB patients.

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“…Given the increasing prevalence of fatty liver and metabolic syndrome in chronic viral hepatitis patients, the impact of concurrent MAFLD in chronic viral hepatitis is a growing concern. 7 Recent studies demonstrated that MAFLD in chronic viral hepatitis patients was associated with increased risk of poor clinical outcome 8 and significant liver fibrosis. 9 However, no study has yet investigated whether chronic viral hepatitis patients at high risk of a poor long-term outcome can be identified based on MAFLD subgroup.…”

Section: Introductionmentioning

confidence: 99%

“…Chronic viral hepatitis can coexist with MAFLD. Given the increasing prevalence of fatty liver and metabolic syndrome in chronic viral hepatitis patients, the impact of concurrent MAFLD in chronic viral hepatitis is a growing concern 7 . Recent studies demonstrated that MAFLD in chronic viral hepatitis patients was associated with increased risk of poor clinical outcome 8 and significant liver fibrosis 9 .…”

Section: Introductionmentioning

confidence: 99%

Diabetic MAFLD is associated with increased risk of hepatocellular carcinoma and mortality in chronic viral hepatitis patients

Kim

Han

Yoo

et al. 2023

Intl Journal of Cancer

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Metabolic dysfunction‐associated fatty liver disease (MAFLD) can coexist with chronic viral hepatitis. MAFLD is a heterogeneous disease because the diagnostic criteria include various metabolic traits. We aimed to identify patients at high risk of poor long‐term outcomes based on MAFLD subgroups in chronic viral hepatitis patients. We evaluated 63 273 chronic hepatitis B and C patients. Patient with a fatty liver index ≥30 was defined to have hepatic steatosis. MAFLD was defined as the presence of hepatic steatosis with any one of the following three conditions, overweight/obesity, type 2 diabetes or ≥2 metabolic risk factors. The prevalence of MAFLD was 38.4% (n = 24 290). During a median 8.8‐year follow‐up, 1839 HCCs and 2258 deaths were documented in MAFLD patients. Among MAFLD patients, diabetes could identify patients at high risk of HCC and mortality, whereas overweight/obesity and metabolic risk factors did not. Compared with non‐MAFLD patients, risk of HCC and mortality was significantly higher in diabetic MAFLD patients (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] = 1.26‐1.43 for HCC; aHR = 1.15, 95% CI = 1.08‐1.22 for mortality). Risk of HCC and mortality was significantly higher in diabetic MAFLD patients (aHR = 1.40, 95% CI = 1.26‐1.55 for HCC; aHR = 1.77, 95% CI = 1.63‐1.93 for mortality) compared with non‐diabetic MAFLD patients. Diabetic MAFLD is associated with increased risk of HCC and mortality among chronic viral hepatitis patients. Our findings highlight the need for close surveillance and effective treatment for these high‐risk patients to reduce HCC and mortality in patients with chronic viral hepatitis.

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Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives

Cited by 43 publications

References 72 publications

Low liver fat in non‐alcoholic steatohepatitis‐related significant fibrosis and cirrhosis is associated with hepatocellular carcinoma, decompensation and mortality

Low liver fat in non‐alcoholic steatohepatitis‐related significant fibrosis and cirrhosis is associated with hepatocellular carcinoma, decompensation and mortality

The interplay between chronic hepatitis B and diabetes mellitus: A narrative and concise review

Diabetic MAFLD is associated with increased risk of hepatocellular carcinoma and mortality in chronic viral hepatitis patients

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