Effect of body mass index on Disease progression in Chronic Hepatitis B Patients
National Hepatology and Tropical Medicine Research Institute, Egypt
Submission: June 25, 2018;Published: January 08, 2019
*Corresponding author: Lamiaa Mobarak, National Hepatology and Tropical Medicine Research Institute, 10 kasr Al-Ainy street, Cairo, Egypt
How to cite this article: Lamiaa Mobarak. Effect of body mass index on Disease progression in Chronic Hepatitis B Patients Curre Res Diabetes
& Obes J. 2019; 9(3): 555761. DOI:10.19080/CRDOJ.2019.09.555761
Background and study aim: In recent years the burden of obesity and metabolic syndrome has been increasing. These diseases are associated with increased risk for chronic hepatitis B virus infection as well as worsened outcomes. The aim of this study was to investigate the association between obesity, defined according to body mass index, and hepatitis B viral load and fibrosis stage among chronic hepatitis B Egyptian patients.
Methods: We performed a retrospective study on 50 patients with chronic hepatitis B virus infection at National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. The essential outcomes were laboratory tests, ultrasonography, and liver biopsy. Data analysis was used to reveal whether high BMI was a variable related to disease progression.
Results: A total of 50 HBsAg seropositive participants. All patients were classified into two groups according to BMI (non-obese, <30 kg/m2; and obese, ≥30 kg/ m2). Obese patients ≥30 kg/m2 were at higher risk for elevated serum levels of ALT (P=0.5) and for lower serum levels of HBV DNA (P=0.08). Bright liver, liver cirrhosis, and splenomegaly were higher in obese patients than in non-obese. A1 was the commonest among obese and non-obese (74.1% and 91.3%) respectively. Also, F1 was the commonest among obese and non-obese (66.7% and 56.5%) respectively. No statistically significant difference was detected between obesity and fibrosis stage.
Conclusion: Subjects with body mass index ≥30 kg/m2 were at higher risk for elevated serum levels of ALT and for lower serum levels of HBV DNA and possible liver cirrhosis based on ultrasonographic findings. We did not find association between obesity and stage of fibrosis.
Keywords: Hepatitis B virus; Body mass index; Liver biopsy; Liver fibrosis; Chronic liver disease; Obesity; Fatty liver disease; Steatosis; Metabolic risk factors; Hepatitis B; Liver disease
Chronic hepatitis B virus (HBV) infection leads to progressive liver fibrosis and is the leading cause of chronic liver disease (CLD) [1,2]. Furthermore, as the incidence of obesity rises in the general population, non-alcoholic fatty liver disease (NAFLD) is also emerging as a disease of significant concern. NAFLD affecting more than 30% of adults in developed countries . Coexistent steatosis is common in chronic hepatitis B infection and is also strongly associated with more advanced liver disease .
Obesity is one of metabolic risk factors associated with NAFLD that have recently emerged as potential cofactors in the development of fibrosis in cases of chronic HCV and HBV [5-7].
Consequently, the evaluation of hepatic fibrosis is highly important in the management of patients with CLD. In spite of certain limitations, histological assessment is the classic method to determine the extent of hepatic fibrosis . As such, we used liver biopsy in the present study, to investigate the relationship between obesity and the risk of liver disease progression in chronic hepatitis B infection among this special patient group.
Patients: This retrospective study included 50 patients with chronic hepatitis B presented to the out-patient clinics of the National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. Diagnosis of HBV was based on detection of HBsAg and quantitative HBV DNA by PCR. Patients with malignancy, decompensated liver disease, Patients with HIV infection or hepatitis B and C co-infection and presence of absolute
contraindication for liver biopsy were excluded from this study.
An informed written consent was obtained from all patients in
the study and according to the Declaration of Helsinki.
Data collection: All patients were subjected to basic
laboratory tests including: Complete blood picture (CBC),
Aspartate aminotransferase (AST), Alanine aminotransferase
(ALT), serum albumin, total bilirubin, INR, Alpha fetoprotein
(AFP), hepatitis seromarkers for HCV (anti HCV) and for hepatitis
B virus (HBV); (HBsAg, anti HBc and anti HBs) using ELISA
technique. HBV DNA was tested by quantitative polymerase
chain reaction (PCR).
The following clinical parameters were recorded: age, sex,
and body mass index (BMI). Ultrasound guided liver biopsies
were performed. Fibrosis was staged according to the METAVIR
scoring system from F0 to F4 as: F0 (no fibrosis), F1 (mild
fibrosis without septa), F2 (moderate fibrosis with few septa),
F3 (severe fibrosis with numerous septa without cirrhosis)
and F4 (cirrhosis) . All patients were classified into two BMI
groupings (non-obese, <30 kg/m2; obese, ≥30 kg/ m2).
Numerical data were presented as means±standard
deviation (S.D), while categorical data were presented as
number (percent). The Mann-Whitney U test and the Chi-square
test were used when appropriate. Statistical significance was
considered if P value was less than or equal 0.05.
The study was conducted on 50 chronic hepatitis B patients.
They presented to the outpatient clinic of the National Hepatology
and Tropical Medicine Research Institute, Cairo, Egypt.
The mean age of obese patients was 39.9+ 7.2 years, while
the mean age of non-obese patients was 33.2+ 10.9 years, with a
statistical significance (P=0.02). There was male predominance
in both groups, without a statistical significance in relation to
sex (P=0.3). Regarding the laboratory results, the significant
difference was confined to hemoglobin which was significantly
higher in obese than in non-obese patients (P=0.02). ALT level
was elevated in obese patients compared with non-obese
without a significant difference (P=0.5).
Obese patients (BMI ≥ 30 kg/m2) had lower HBV DNA
PCR than in non-obese, however, did not show a statistical
significance (P=0.08) (Table 1).
The ultrasound findings showed that bright liver, liver
cirrhosis, and splenomegaly were higher in obese patients
than in non-obese. There was not a statistical significance in
abdominal ultrasonographic findings between both groups. A1
was the commonest among obese and non-obese (74.1% and
91.3%) respectively. Also, F1 was the commonest among obese
and non-obese (66.7% and 56.5%) respectively. No statistically
significant difference was detected between obesity and fibrosis
stage (Table 2).
Chronic hepatitis B virus (HBV) infection is a challenging
disease worldwide . It is well-known that HBV infection is a
main risk factor for hepatic fibrosis, cirrhosis and hepatocellular
carcinoma (HCC) [11-14]. It is significant to exactly predict
the stage of liver fibrosis progression in chronic viral hepatitis
patients, which has significant implications for prognosis and
Metabolic syndrome (MS) involves three characteristics
of the following: dyslipidemia, an impaired fasting glucose
metabolism, hypertension or central obesity [15,16].
It is vastly known that hepatitis C virus infection might
increase the risk of metabolic syndrome and diabetes mellitus
[17,18]. HBV and its relationship with metabolic syndrome have
also become a focus of research . In the current study, we
investigated whether obesity, according to body mass index,
was associated with higher hepatitis B viral load and more
progressive disease in chronic hepatitis B Egyptian patients.
There are only few studies regarding the relationships of
chronic hepatitis B infection with obesity. In the present study
we did not find any association between chronic hepatitis B
infection and obesity, as Obese patients (BMI ≥ 30 kg/m2) had
lower HBV DNA PCR than in non-obese, however, it did not
show a statistical significance (P=0.08). This is consistent with
previous studies [20,21] which found that extreme obesity
was associated with low HBV viral load and was a significant
predictor of HBsAg seroclearance in chronic hepatitis B patients.
This may be a reason why HBV patients with higher BMI had less
fatty liver. Jinjuvadia et al,  observed among patients with
chronic HBV infection, a lower odd of having central obesity.
The relationship between chronic HBV infection, and
abnormal liver function, is complex. Patients with chronic
HBV infection have a higher risk of abnormal liver function,
such as elevated ALT levels . Previous studies have also
confirmed the predictive role of an elevated ALT level with an
increased incidence of metabolic syndrome [23,24], and it is
consistent with the present study as ALT level was elevated in
obese patients compared with non-obese without a significant
High BMI is involved in the transition from HBV carrier state
to hepatocellular carcinoma (HCC) and liver-related mortality
[25,26]. Similarly, in the present study the ultrasound findings
showed that bright liver, liver cirrhosis, and splenomegaly were
higher in obese patients than in non-obese.
In a study including 850 HBV patients, the prevalence of MS
was found to be 5%. The extent of liver fibrosis was found more
serious in patients accompanying metabolic syndrome. Body
mass index (BMI) was one of the factors that showed association
with advanced fibrosis (fibrosis stages 3 to 4). In multivariate
analysis, metabolic syndrome was found to be independently
associated with liver fibrosis .
In a recent prospective cohort study of 663 CHB patients,
obesity was found to be associated with liver fibrosis progression
. Even the effect of such coincident, metabolic syndrome
was most apparent in the immune tolerant phase. Its effect
was independent of the change in viral load and ALT level .
This is supported by the observation from a survey in general
population that CHB is associated with a lower prevalence of
fatty liver, hypertriglyceridemia and metabolic syndrome .
These studies are consistent with the current study in which
obese subjects with BMI ≥ 30 kg/m2 were not associated with
advanced fibrosis as shown in histologic examination.
Subjects with body mass index ≥30 kg/m2 were at higher
risk for elevated serum levels of ALT and for lower serum levels of
HBV DNA and possible liver cirrhosis based on ultrasonographic
findings. We did not find association between obesity and stage