Fatty Liver Disease Prevalent in Patients With Chronic Hepatitis B Virus

Destruction of hepatitis B virus by silver nanoparticles, computer illustration. Conceptual image for hepatitis B treatment and prevention by using nanotechnology.
Researchers assessed whether chronic hepatitis B virus infection is associated with an increased risk for fatty liver disease.

The prevalence of fatty liver disease was increased among patients with chronic hepatitis B virus (HBV) infection compared with the general population, according to findings published in the Arab Journal of Gastroenterology.

Patients (N=255) with chronic HBV infection were enrolled at the Van Training and Research Hospital in Turkey in 2019 for inclusion in this cross-sectional, retrospective study. The researchers aimed to investigate the frequency of fatty liver disease among this patient population, as well as potential risk factors. Hepatobiliary ultrasonography was performed to determine the presence and severity grade of fatty liver disease.

Among patients with (n=95) and without (n=119) fatty liver disease included in the analysis, the median age was 40 and 44 years (P =.045), 55 and 69 patients were men, and the median duration of chronic HBV infection was 73 and 74 months, respectively.

All patients were positive for hepatitis B surface antigens, 96.4% were positive for hepatitis B(e) antibodies, and 3.5% were positive for hepatitis B(e) antigens.

The patients with fatty liver disease had increased concentrations of triglycerides (median, 187.62 vs 133.27 mg/dL; P =.009) and gamma-glutamyl transpeptidase (GGT; median, 22.43 vs 17.30 U/L; P =.02) vs those without the disease.

Stratified by HBV viral load, increased HBV viral loads (>20,000 IU/mL) were significantly more likely among patients who were younger (P =.022). Increased concentrations of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), as well as a higher AST to platelet ratio index score, were positively associated with an increased HBV viral load (all P =0.000).

Analysis via Spearman correlation showed that HBV viral load was correlated with ALT (r, 0.228; P =.01) and AST (r, 0.223; P =.01) concentrations, as well as APRI scores (r, 0.184; P =.008). Further analysis showed that the occurrence of steatosis was correlated with age (r, 0.165; P =.008), GGT (r, 0.133; P =.034), and triglyceride concentration (r, 0.235; P =.037); and ALT was correlated with APRI score (r, 0.606; P =0.000).

Overall, the prevalence of fatty liver disease among this patient population was 44.4%, which was significantly decreased compared with the general population (range, 10.6%-19.8%). Owing to these findings, the researchers determined that chronic HBV infection significantly increases the risk for fatty liver disease (relative risk [RR], 2.23; 95% CI, 1.75-2.86).

This study was limited as the presence of fatty liver disease was not determined via analysis of liver biopsy specimens.

According to the researchers, “[these] findings emphasize…that attention should be paid to the presence of hepatosteatosis and… patients’ lipid profiles during abdominal [ultrasonography] examination performed for screening purposes in patients [with chronic HBV infection].”


Sayar MS, Bulut D, Acar A. Evaluation of hepatosteatosis in patients with chronic hepatitis B virus infection. Arab J Gastroenterol. 2022;S1687-1979(22)00035-1. doi:10.1016/j.ajg.2022.05.002