Risk factors of metabolic dysfunction-associated steatotic liver disease in a cohort of patients with chronic hepatitis B
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background & Aims
Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) commonly co-exist, with conflicting data in prevalence and disease severity. We aimed to investigate these discrepancies.
Methods
This multicenter study included consecutive patients with CHB from 19 European centers. A survey on standard of care for MASLD screening in CHB was circulated.
Results
A total of 1709 patients with CHB were included; median age, 53 years (interquartile range [IQR], 42–64); males, 60.7%; body mass index (BMI), 25.6 kg/m2 (IQR, 14–63 kg/m2); and 57.3% White. MASLD prevalence (1510 consecutive patients) was 42.3%. BMI (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19–1.36), ferritin (OR, 1.00; 95% CI, 1.00–1.00) and type 2 diabetes (OR, 2.60; 95% CI, 1.12–6.02) were independently associated with MASLD. The prevalence of advanced fibrosis was 18% (255/1420) in the whole cohort, 25.4% (162/639) among patients with CHB with MASLD, and 13.7% in those without MASLD. Independent predictors of advanced fibrosis were MASLD (OR, 2.76; 95% CI, 1.50–5.05), BMI (OR, 1.08; 95% CI, 1.02–1.15), alanine transaminase (OR, 1.01; 95% CI, 1.00–1.03), lower platelets (OR, 0.99; 95% CI, 0.98–0.99), insulin treatment (OR, 13.88; 95% CI, 2.95–65.28), and long-term antivirals (OR, 4.86; 95% CI, 2.40–9.85). During follow-up (48 months), only patients without MASLD showed significant liver stiffness measurement improvement over time (P < .001). Among patients with MASLD, Fibrosis-4 and liver stiffness measurement performed moderately at predicting advanced fibrosis (area under the receiver operating characteristic curve = 0.71 vs 0.70; P = .38) against histology. As standard of care, 68.4% of centers screened all patients with CHB for MASLD; 52.6% followed the same treatment indication in those with CHB and MASLD vs CHB only.
Conclusions
In this large European cohort, MASLD and fibrosis were highly prevalent among patients with CHB, whereas MASLD aggravated liver fibrosis. Though screening strategies remain inconsistent, ferritin levels, increased BMI, and type 2 diabetes may inform on the presence of MASLD. Biomarkers showed modest performance in predicting fibrosis.
Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) commonly co-exist, with conflicting data in prevalence and disease severity. We aimed to investigate these discrepancies.
Methods
This multicenter study included consecutive patients with CHB from 19 European centers. A survey on standard of care for MASLD screening in CHB was circulated.
Results
A total of 1709 patients with CHB were included; median age, 53 years (interquartile range [IQR], 42–64); males, 60.7%; body mass index (BMI), 25.6 kg/m2 (IQR, 14–63 kg/m2); and 57.3% White. MASLD prevalence (1510 consecutive patients) was 42.3%. BMI (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.19–1.36), ferritin (OR, 1.00; 95% CI, 1.00–1.00) and type 2 diabetes (OR, 2.60; 95% CI, 1.12–6.02) were independently associated with MASLD. The prevalence of advanced fibrosis was 18% (255/1420) in the whole cohort, 25.4% (162/639) among patients with CHB with MASLD, and 13.7% in those without MASLD. Independent predictors of advanced fibrosis were MASLD (OR, 2.76; 95% CI, 1.50–5.05), BMI (OR, 1.08; 95% CI, 1.02–1.15), alanine transaminase (OR, 1.01; 95% CI, 1.00–1.03), lower platelets (OR, 0.99; 95% CI, 0.98–0.99), insulin treatment (OR, 13.88; 95% CI, 2.95–65.28), and long-term antivirals (OR, 4.86; 95% CI, 2.40–9.85). During follow-up (48 months), only patients without MASLD showed significant liver stiffness measurement improvement over time (P < .001). Among patients with MASLD, Fibrosis-4 and liver stiffness measurement performed moderately at predicting advanced fibrosis (area under the receiver operating characteristic curve = 0.71 vs 0.70; P = .38) against histology. As standard of care, 68.4% of centers screened all patients with CHB for MASLD; 52.6% followed the same treatment indication in those with CHB and MASLD vs CHB only.
Conclusions
In this large European cohort, MASLD and fibrosis were highly prevalent among patients with CHB, whereas MASLD aggravated liver fibrosis. Though screening strategies remain inconsistent, ferritin levels, increased BMI, and type 2 diabetes may inform on the presence of MASLD. Biomarkers showed modest performance in predicting fibrosis.
Date Issued
2026-03-01
Date Acceptance
2025-06-02
Citation
Clinical Gastroenterology and Hepatology, 2026, 24 (3), pp.701-712.e8
ISSN
1542-3565
Publisher
Elsevier
Start Page
701
End Page
712.e8
Journal / Book Title
Clinical Gastroenterology and Hepatology
Volume
24
Issue
3
Copyright Statement
© 2026 The Author(s). Published by Elsevier Inc. on behalf of the AGA Institute. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://doi.org/10.1016/j.cgh.2025.06.014
Publication Status
Published
Date Publish Online
2025-07-02