Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Does increased body mass index with hepatic steatosis contribute to seroclearance of hepatitis B virus (HBV) surface antigen in chronic HBV infection?

Abstract

Background:

Overweight and hepatic steatosis have been increasingly recognized recently. This study aimed to test whether substantial amount of fatty infiltration in liver, which may interfere with cytoplasmic distribution of hepatitis B surface antigen (HBsAg), can contribute to HBsAg seroclearance in HBsAg carriers.

Methods:

Clinical and laboratory data including ultrasound grading of hepatic steatosis were studied in 54 HBsAg carriers with HBsAg seroclearance, and the results were compared with 108 age- and sex-matched carriers with HBsAg persistence.

Results:

Body mass index and ultrasound grading of hepatic steatosis were significantly higher in HBsAg carriers with HBsAg seroclearance than in those with HBsAg persistence. The degrees of hepatic steatosis correlated significantly with body mass index (P<0.001). The prevalence of mild hepatic steatosis showed no significant difference (33% (18/54) vs 31% (33/108), P=0.72), but moderate–severe hepatic steatosis was significantly more prevalent in patients with HBsAg seroclearance (33% (18/54) vs 13% (17/108), P=0.01). HBsAg carriers with moderate and severe hepatic steatosis were associated with a 3.2-fold (95% confidence interval: 1.2–8.4, P=0.02) and 3.9-fold (95% confidence interval: 1.1–14.2, P=0.04), respectively, increased odds of HBsAg seroclearance compared to those without hepatic steatosis.

Conclusion:

Moderate–severe hepatic steatosis may contribute to HBsAg seroclearance in HBsAg carriers.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Chu CM, Karayiannis P, Fowler MJ, Monjardino J, Liaw YF, Thomas HC . Natural history of chronic hepatitis B virus infection in Taiwan: studies of hepatitis B virus DNA in serum. Hepatology 1985; 5: 431–434.

    Article  CAS  Google Scholar 

  2. Chu CM . Natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular carcinoma. J Gastroenterol Hepatol 2000; 15 (Suppl): E25–E30.

    Article  Google Scholar 

  3. Wu TT, Hsu HC, Chen DS, Sheu JC, Su IJ, Chen SL et al. Clearance of hepatitis B surface antigen (HBsAg) after surgical resection of hepatocellular carcinoma. J Hepatol 1987; 4: 45–51.

    Article  CAS  Google Scholar 

  4. Liaw YF, Sheen IS, Chen TJ, Chu CM, Pao CC . Incidence, determinants and significance of delayed clearance of serum HBsAg in chronic hepatitis B virus infection: a prospective study. Hepatology 1991; 13: 627–631.

    Article  CAS  Google Scholar 

  5. Da Silva LC, Madruga CL, Carrilho FJ, Pinho JR, Saez-Alquezar A, Santos C et al. Spontaneous hepatitis B surface antigen clearance in a long-term follow-up study of patients with chronic type B hepatitis. Lack of correlation with hepatitis C and D virus superinfection. J Gastroenterol 1996; 31: 696–701.

    Article  CAS  Google Scholar 

  6. Sampliner RE, Hamilton FA, Iseri OA, Tabor E, Boitnott J . The liver histology and frequency of clearance of the hepatitis. Am J Med Sci 1979; 277: 17–22.

    Article  CAS  Google Scholar 

  7. Alward WL, McMahon BJ, Hall DB, Heyward WL, Francis DP, Bender TR . The long-term serological course of asymptomatic hepatitis B virus carriers and the development of primary hepatocellular carcinoma. J Infect Dis 1985; 151: 604–609.

    Article  CAS  Google Scholar 

  8. McMahon BJ, Holck P, Bulkow L, Snowball M . Serologic and clinical outcomes of 1536 Alaska Natives chronically infected with hepatitis B virus. Ann Intern Med 2001; 135: 759–768.

    Article  CAS  Google Scholar 

  9. Sheen IS, Liaw YF, Lin DY, Chu CM . Role of hepatitis C and delta viruses in the termination of chronic hepatitis B surface antigen carrier state: a multivariate analysis in a longitudinal follow-up study. J Infect Dis 1994; 170: 358–361.

    Article  CAS  Google Scholar 

  10. Liaw YF, Chen YC, Sheen IS, Chien RN, Yeh CT, Chu CM . Impact of acute hepatitis C virus superinfection in patients with chronic hepatitis B virus infection. Gastroenterology 2004; 126: 1024–1029.

    Article  Google Scholar 

  11. Chen YC, Sheen IS, Chu CM, Liaw YF . Prognosis following spontaneous HBsAg seroclearance in chronic hepatitis B patients with or without concurrent infection. Gastroenterology 2002; 123: 1084–1089.

    Article  Google Scholar 

  12. Chu CM, Liaw YF . Intrahepatic distribution of hepatitis B surface and core antigens in chronic hepatitis B virus infection. Hepatocyte with cytoplasmic/membranous hepatitis B core antigen as a possible target for immune hepatocytolysis. Gastroenterology 1987; 92: 220–225.

    Article  CAS  Google Scholar 

  13. Chu CM, Liaw YF . Membrane staining for hepatitis B surface antigen on hepatocytes: a sensitive and specific marker of active viral replication in hepatitis B. J Clin Pathol 1995; 48: 470–473.

    Article  CAS  Google Scholar 

  14. Chu CM, Sheen IS, Lin SM, Liaw YF . Sex difference in chronic hepatitis B virus infection: studies of serum HBeAg and alanine aminotransferase levels in 10 431 asymptomatic Chinese HBsAg carriers. Clin Infect Dis 1993; 16: 709–713.

    Article  CAS  Google Scholar 

  15. Chu CM, Hung SJ, Lin J, Tai DI, Liaw YF . Natural history of hepatitis B e antigen to antibody seroconversion in patients with normal serum aminotransferase levels. Am J Med 2004; 116: 829–834.

    Article  CAS  Google Scholar 

  16. Lin DY, Sheen IS, Chiu CT, Lin SM, Kuo YC, Liaw YF . Ultrasonographic changes of early liver cirrhosis in chronic hepatitis B: a longitudinal study. J Clin Ultrasound 1993; 21: 303–308.

    Article  CAS  Google Scholar 

  17. Saverymuttu SH, Joseph AEA, Maxwell MD . Ultrasound scanning in the detection of hepatic fibrosis and steatosis. BMJ 1986; 292: 13–15.

    Article  CAS  Google Scholar 

  18. Needleman L, Kurz AB, Rifkin MD, Cooper HS, Pasto ME, Goldberg BB . Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading. Am J Roentgenol 1986; 146: 1011–1015.

    Article  CAS  Google Scholar 

  19. Joseph AE, Saverymuttu SH, al-Sam S, Cook MG, Maxwell JD . Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol 1991; 43: 26–31.

    Article  CAS  Google Scholar 

  20. Lin DY, Sheen IS, Chiu CT, Lin SM, Kuo YC, Chien RN . Clinical significance of ultrasonographical fatty liver in asymptomatics: analysis of 1040 check-up subjects. J Med Ultrasound 1993; 1: 165–171.

    Google Scholar 

  21. Lin YC, Yen LL, Chen SY, Kao MD, Tzeng MS, Huang PC et al. Prevalence of overweight and obesity and its associated factors: findings from National Nutrition and Health Survey in Taiwan, 1993–1996. Prev Med 2003; 37: 233–241.

    Article  Google Scholar 

  22. Altlparmak E, Koklu S, Yalinkilic M, Yuksel O, Cicek B, Kayacetin E et al. Viral and host causes of fatty liver in chronic hepatitis B. World J Gastroenterol 2005; 11: 3056–3059.

    Article  Google Scholar 

  23. Patton HM, Patel K, Behling C, Bylund D, Blatt LM, Vallee M et al. The impact of steatosis on disease progression and early and sustained treatment response in chronic hepatitis C patients. J Hepatol 2004; 40: 484–490.

    Article  Google Scholar 

  24. Hu KQ, Kyulo NL, Esrailian E, Thompson K, Chase R, Hillebrand DJ et al. Overweight and obesity, hepatic steatosis, and progression of chronic hepatitis C: a retrospective study on a large cohort of patients in the United States. J Hepatol 2004; 40: 147–154.

    Article  CAS  Google Scholar 

  25. Chu CM, Liaw YF . Genotype C hepatitis B virus infection is associated with a higher risk of reactivation of hepatitis B and progression to cirrhosis than genotype B: a longitudinal study of hepatitis B e antigen-positive patients with normal aminotransferase levels at baseline. J Hepatol 2005; 43: 411–417.

    Article  CAS  Google Scholar 

  26. Yuen MF, Wong DK, Sablon E, Tse E, Ng IO, Yuan HJ et al. HBsAg seroclearance in chronic hepatitis B in the Chinese: virological, histological, and clinical aspects. Hepatology 2004; 39: 1694–1701.

    Article  Google Scholar 

  27. Rehermann B, Lau D, Hoofnagle JH, Chisari FV . Cytotoxic T lymphocyte responsiveness after resolution of chronic hepatitis B virus infection. J Clin Invest 1996; 97: 1655–1665.

    Article  CAS  Google Scholar 

  28. Feldstein AE, Canbay A, Angulo P, Taniai M, Burgart LJ, Lindor KD et al. Hepatocyte apoptosis and fas expression are prominent features of human nonalcoholic steatohepatitis. Gastroenterology 2003; 125: 437–443.

    Article  Google Scholar 

  29. Jan CF, Chen CJ, Chiu YH, Chen LS, Wu HM, Huang CC et al. A population-based study investigating the association between metabolic syndrome and Hepatitis B/C infection (Keelung Community-based Integrated Screening Study No. 10). Int J Obes Relat Metab Disoed (London) 2006; 30: 794–799.

    Article  Google Scholar 

  30. Ratziu V, Poynard T . NASH: a hidden and silent fibroser finally revealed? J Hepatol 2005; 42: 132–138.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C-M Chu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chu, CM., Lin, DY. & Liaw, YF. Does increased body mass index with hepatic steatosis contribute to seroclearance of hepatitis B virus (HBV) surface antigen in chronic HBV infection?. Int J Obes 31, 871–875 (2007). https://doi.org/10.1038/sj.ijo.0803479

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0803479

Keywords

This article is cited by

Search

Quick links