title: Metabolic syndrome increases the risk of liver cirrhosis in chronic hepatitis B.
abstract: BACKGROUND
  Metabolic syndrome is associated with non-alcoholic steatohepatitis and cryptogenic cirrhosis. Whether metabolic syndrome affects the severity of chronic hepatitis B (CHB) is unclear.
  
  
  OBJECTIVE
  We aimed to study the relationship between metabolic syndrome and the risk of liver cirrhosis in patients with CHB.
  
  
  METHODS
  We prospectively recruited patients with CHB from primary care and hospital clinics for liver stiffness measurement (LSM) with transient elastography to diagnose early cirrhosis. Probable cirrhosis was defined as LSM >or=13.4 kPa. We analysed a subgroup of patients with paired LSM and liver biopsies to validate the accuracy of LSM.
  
  
  RESULTS
  1466 patients had reliable LSM and 134 (9%) patients had adequate liver biopsy. 188 (13%) patients had metabolic syndrome. Histological liver cirrhosis was present in 32/134 (24%) patients. Histological liver cirrhosis was more common among patients who had metabolic syndrome (38%) versus those who did not (11%, p<0.001). The specificity of probable cirrhosis on LSM for histological cirrhosis was 94%. Probable cirrhosis was present in 187 (13%) patients. Metabolic syndrome was more prevalent in patients with probable cirrhosis (24%) than those without cirrhosis (11%, p<0.001). After adjustment for anthropometric, biochemical and virological factors, metabolic syndrome remained an independent factor associated with probable cirrhosis (odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.6). The odds ratios of probable cirrhosis were 1.4 (95% CI, 0.9 to 2.3), 2.6 (95% CI, 1.7 to 4.3), 4.1 (95% CI, 2.4 to 7.1), 4.0 (95% CI, 1.9 to 8.4) and 5.5 (95% CI, 1.8 to 16.7) in patients with one, two, three, four and five components of metabolic syndrome, respectively.
  
  
  CONCLUSIONS
  Metabolic syndrome is an independent risk factor of liver cirrhosis in CHB.
authors.affiliation: Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: G L-H
authors.initials: GL
authors.lastname: Wong
authors.forename: V W-S
authors.initials: VW
authors.lastname: Wong
authors.forename: P C-L
authors.initials: PC
authors.lastname: Choi
authors.forename: A W-H
authors.initials: AW
authors.lastname: Chan
authors.forename: A M-L
authors.initials: AM
authors.lastname: Chim
authors.forename: K K-L
authors.initials: KK
authors.lastname: Yiu
authors.forename: H-Y
authors.initials: HY
authors.lastname: Chan
authors.forename: F K-L
authors.initials: FK
authors.lastname: Chan
authors.forename: J J-Y
authors.initials: JJ
authors.lastname: Sung
authors.forename: H L-Y
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000328:Adult; D017677:Age Distribution; D001706:Biopsy; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques; D004812:Epidemiologic Methods; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000453:epidemiology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D008875:Middle Aged; D011446:Prospective Studies