Metabolic Syndrome Associated With Higher ALT Levels in Chronic Hepatitis B

Liver function test
Liver function test
Findings highlight the importance of screening for metabolic syndrome (MS) and the potential for MS to influence alanine aminotransferase and its interpretation in the context of HBV treatment decisions.

About 1 in 4 people with chronic hepatitis B (HBV) infection who reside in North America have metabolic syndrome, which was also independently associated with higher alanine aminotransferase (ALT) levels over time, according to a new study published in Diabetes Care.

Metabolic syndrome is a risk factor for chronic liver disease progression, and aside from being directly associated with nonalcoholic fatty liver disease, metabolic syndrome could influence outcomes in other chronic liver diseases.

In this study, the prevalence of metabolic syndrome and its association with ALT levels and fibrosis was examined in a large cohort of 777 North American individuals with chronic HBV infection. Median follow-up was 3.7 years, and within this group, 171 individuals (22%) had metabolic syndrome.

There was a significantly lower prevalence of hepatitis B e antigen in patients with metabolic syndrome (14.2% vs 30.3%; P =.0002) and lower HBV DNA levels (median log10 value 3.23 vs 3.96; P <.0001) vs patients without. The investigators note that this observation was probably due to the older age and longer duration of HBV infection in patients with metabolic syndrome.

Adjusted multivariable analysis of serial ALT values showed that ALT was significantly higher in people with metabolic syndrome at baseline (mean 12%; P =.02) and even higher in people with persistent metabolic syndrome (mean 19%; P =.003). Liver biopsy results (n=77) showed that higher grades of steatosis and higher scores for perisinusoidal fibrosis in patients with metabolic syndrome and they were more likely have definite steatohepatitis (30% vs 2%).

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“While absolute increases in ALT values were modest, they may be of clinical consequence in persons with ALT values at or near the threshold for consideration of antiviral therapy,” conclude the investigators.


Khalili M, Shuhart MC, Lombardero M, et al; Hepatitis B Research Network (HBRN). Relationship between metabolic syndrome, alanine aminotransferase levels, and liver disease severity in a multiethnic North American cohort with chronic hepatitis B [published online March 29, 2018]. Diabetes Care. doi:10.2337/dc18-0040

This article originally appeared on Endocrinology Advisor