title: Prevalence of steatosis and insulin resistance in patients with chronic hepatitis B compared with chronic hepatitis C and non-alcoholic fatty liver disease.
abstract: The association of NAFLD with chronic hepatitis C (CHC) has been extensively studied but little is known about its coexistence with chronic hepatitis B (CHB).
  
  
  OBJECTIVE
  To investigate the prevalence and determinants of steatosis and insulin resistance (IR) in CHB and its consequences on liver injury compared with CHC and NAFLD.
  
  
  METHODS
  Patients with CHB (N=110), CHC (N=111) and NAFLD (N=136) were evaluated by biomarkers of steatosis (SteatoTest>0.38 as a surrogate for steatosis >5%), IR (HOMA-IR>2.7 as a surrogate for IR) and fibrosis (FibroTest>0.48 as a surrogate for significant fibrosis, ≥F2).
  
  
  RESULTS
  HOMA-IR gradually increased in CHB, CHC and NAFLD: 2.3±1.8; 3±2.6 and 3.8±2.7 (p<0.001). The prevalence of steatosis >5% was 21% (CHB), 43% (CHC) and 82% (NAFLD), (p<0.001). The prevalence of fibrosis≥F2 was 10% (CHB), 42% (CHC) and 21% (NAFLD), p<0.001. In CHB, IR was related to host and not viral factors. CHB patients with steatosis had higher BMI (29±5.7kg/m(2) vs. 24±4kg/m(2), p<0.001), waist circumference (96±14cm vs. 84±11cm, p=0.001) and HOMA-IR (3.9±2.6 vs. 1.8±1.2, p<0.001) than those without steatosis. HOMA-IR independently predicted steatosis in CHB (OR=1.9, 95% CI, 1.09-3.27, p<0.05) and CHC (OR=1.38; 95% CI, 1.07-1.78, p<0.02). In CHB, metabolic risk factors and HOMA-IR were not associated with significant fibrosis. HOMA-IR was an independent predictor of fibrosis in CHC.
  
  
  CONCLUSIONS
  Steatosis may co-exist in CHB patients but with a lower prevalence than in CHC and NAFLD. In CHB steatosis is related to host and not viral factors, and is not associated with the severity of fibrosis.
authors.affiliation: Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France; INSERM, UMRS 938, Paris, France. Electronic address: ralu_pais@yahoo.com.
authors.forename: Raluca
authors.initials: R
authors.lastname: Pais
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Clinic of Internal Medicine and Nephrology, Fundeni Clinical Institute, Bucharest, Romania. Electronic address: ela.rusu@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Rusu
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Clinic of Internal Medicine and Nephrology, Fundeni Clinical Institute, Bucharest, Romania. Electronic address: diamicu@gmail.com.
authors.forename: Diana
authors.initials: D
authors.lastname: Zilisteanu
authors.affiliation: Clinic of Internal Medicine and Nephrology, Fundeni Clinical Institute, Bucharest, Romania. Electronic address: alexandra.circiumaru@gmail.com.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Circiumaru
authors.affiliation: Clinic of Internal Medicine and Nephrology, Fundeni Clinical Institute, Bucharest, Romania. Electronic address: laurentiumicu2000@yahoo.com.
authors.forename: Laurentiu
authors.initials: L
authors.lastname: Micu
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Clinic of Internal Medicine and Nephrology, Fundeni Clinical Institute, Bucharest, Romania. Electronic address: mihaiv45@gmail.com.
authors.forename: Mihai
authors.initials: M
authors.lastname: Voiculescu
authors.affiliation: Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France; INSERM, UMRS 938, Paris, France. Electronic address: tpoynard@teaser.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.affiliation: Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France; INSERM, UMRS 938, Paris, France. Electronic address: vlad.ratziu@upmc.fr.
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000378:metabolism; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance; D008103:Liver Cirrhosis; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000378:metabolism; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D014280:Triglycerides / Q000378:metabolism; D019562:Viral Load; D055105:Waist Circumference; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D014280:Triglycerides; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Chronic hepatitis B; Chronic hepatitis C; Fatty liver; Insulin resistance; Metabolic risk factors; Steatohepatitis