Effect of Non-alcoholic Fatty Liver Disease on Transaminase Levels and Transient Elastography in Patients with Chronic Hepatitis B

Abstract

ObjectiveTo investigate the effects of non-alcoholic fatty liver disease on aminotransferase (ALT) levels and transient elastography in patients with chronic hepatitis B (CHB).MethodsA cross-sectional study of 230 patients with CHB and ALT levels up to two times the upper limits of normal, of one-year duration, from June 2018 to May 2019. The demographic, clinical, and laboratory characteristics of each patient were collected. Transient elastography was performed to evaluate controlled attenuation parameter (CAP or steatosis) and liver stiffness (fibrosis).ResultsA total of 161 (70%) patients were overweight, with over two-thirds (166; 72.2%) having elevated ALT >35 U/L. Three-fourths of the patients (178; 77.4%) had a hepatitis B virus (HBV) deoxyribonucleic (DNA) level of less than 2000 IU/ml. Steatosis was detected in 166 (72.2%) patients while fibrosis of F2 or more in 88 (38.3%). Multivariate regression analysis showed that weight, homeostatic model assessment of insulin resistance (HOMA-IR), and elevated ALT levels of more than 35 were independently associated with higher CAP values (p= 0.019, 0.001, and 0.004, respectively). Age, insulin levels, and platelet counts were independently associated with liver elasticity (p=0.00, 0.002, and 0.028, respectively). HBV DNA levels did not show any significant association with CAP score, liver stiffness, and HOMA-IR or ALT level. Among those with an elevated ALT of 35 or above (n=166), 124 patients had HBV DNA levels less than 2000 IU/ml. Out of these, 97 (78.2%) patients had steatosis and 51 (41.1%) had F2 or more fibrosis.ConclusionA significant number of patients with CHB with mildly elevated ALT levels are overweight, have significant steatosis and fibrosis, but low HBV DNA levels. This aspect is important while making decisions regarding hepatitis B treatment.

Factors Associated with Hepatic Steatosis in Black African Subjects with Chronic Viral Hepatitis B in Côte d’Ivoire

“…72.2% [13]. This difference with our study could be explained by the fact that in this study, nearly 70% of the patients had a BMI greater than 30 and the effect of obesity on the presence of hepatic steatosis is well known in the literature [1].…”

“…Sun et al in China in 2019 found that high weight and high blood pressure were associated with the presence of steatosis [19]. Asim et al found that weight, insulin resistance and high transaminase levels were related to higher grades of steatosis [13]. Altiparmak et al found in their patients in whom steatosis had been diagnosed by pathological examination, that they had an average age, a BMI, higher cholesterol and triglyceride levels than patients without steatosis [20].…”

Alterations in the Gut Microbiota and Hepatitis-B-Virus Infection in Southern Chinese Patients With Coexisting Non-Alcoholic Fatty Liver Disease and Type-2 Diabetes Mellitus

“…The number of patients who have hepatitis B virus (HBV) infection, NAFLD, and T2DM is high (13). The prognosis of coexisting chronic hepatitis B (CHB) and NAFLD is worse than that of CHB alone or NAFLD alone (14,15).…”

Metabolic syndromes, hepatitis B virus (HBV), and hepatitis C virus as three factors involved in the development of hepatic steatosis: a systematic review and meta-analysis

“…The data of 24 studies such as first author, year, country, number of hepatic steatosis patients, age and gender distribution, number of hepatic steatosis patients with viral hepatitis infection, risk of viral hepatitis in hepatic steatosis, and reference number are listed in Table 1[17–40]. For assessing the quality of eligible studies, the Newcastle-Ottawa Scale checklist was used.…”