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 log¹⁰ 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.

Keywords:

• chronic hepatitis B
• metabolic dysfunction-associated fatty liver disease
• hepatic steatosis
• cirrhosis

Abbreviations

CHB, chronic hepatitis B; MAFLD, metabolic dysfunction-associated fatty liver disease; HBV, hepatitis B virus; HS, hepatic steatosis; NAFLD, nonalcoholic fatty liver disease; HCC, hepatocellular carcinoma; DM, diabetes mellitus; GHE, Global Health Estimates; IPTW, inverse probability treatment weighting; HR, hazard ratio; OR, odds ratio; CI, confidence interval; IQR, interquartile range; MR, magnetic resonance; CT, computed tomography; BMI, body mass index; ALP, alkaline phosphatase; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; UA, uric acid; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; HBeAg, hepatitis B e antigen; HOMA-IR, homeostatic model assessment of insulin resistance.

Data Sharing Statement

The datasets supporting the conclusions of the current study are available at Guangdong Provincial Hospital of Chinese Medicine, which are available from the corresponding author on reasonable request. The data are not publicly available due to privacy or ethical restrictions.

Ethics Approval and Informed Consent

All procedures in this retrospective study were performed following the ethical standards of the institutional and national research committee and were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Approval for these investigations was obtained from the Ethics Committee of the Guangdong Provincial Hospital of Chinese Medicine (approval number: YE2021-200-01). This study is a retrospective, observational, non-interventional study that only analyzed data from medical records from previous clinical treatment. Therefore, the Ethics Committee of the Guangdong Provincial Hospital of Chinese Medicine agreed to waive informed consent. All data was anonymized and maintained with confidentiality.

Consent for Publication

All authors agree to publish this manuscript.

Disclosure

All authors declare that they have no conflicts of interest.

Additional information

Funding

The present study was funded by the Thirteen Five-Year Plan for Major and Special Program of the National Science and Technology of China (2018ZX10725506-003 and 2018ZX10725505-004); the biological resources project collaborated by Guangdong Provincial Hospital of Chinese Medicine and Shanghai chip National Engineering Center (YN2016XP03), the Science and Technology research project of Traditional Chinese Medicine of Guangdong Provincial Hospital of Chinese Medicine(YN2021DB07), and the Clinical research projects of Guangdong Provincial Hospital of Chinese Medicine (YN10101903).