Does Metabolic Dysfunction Affect Liver Fibrosis in Hep B?

TOPLINE:

Metabolic dysfunction-associated steatotic liver disease (MASLD) was prevalent in more than 40% of patients with chronic hepatitis B and was independently associated with advanced fibrosis.

METHODOLOGY:

• This cross-sectional study was conducted at 19 specialised hepatology centres across five European countries to assess the prevalence and risk factors for MASLD and fibrosis.
• This study included 1709 consecutive patients with chronic hepatitis B (median age, 53 years; 60.7% men; 57.3% White), defined as the persistence of hepatitis B surface antigen for at least 6 months.
• MASLD was diagnosed using ultrasound, histology, and/or transient elastography, with a controlled attenuation parameter score ≥ 275 dB/m with at least one metabolic risk factor.
• In patients with chronic hepatitis B and MASLD, advanced fibrosis was defined as liver stiffness measurement values ≥ 8 kPa.

TAKEAWAY:

• The prevalence of MASLD in patients with chronic hepatitis B was 42.3% and that of advanced fibrosis was 18%. Advanced fibrosis was more common in those with MASLD than in those without MASLD (25.4% vs 13.7%).
• In the multivariate analysis, BMI and type 2 diabetes were independently associated with MASLD in patients with chronic hepatitis B (odds ratio [OR], 1.27; P < .001 and OR, 2.60; P = .03, respectively).
• Factors associated with advanced fibrosis in patients with chronic hepatitis B included MASLD (OR, 2.78; 95% CI, 1.50-5.05), BMI (OR, 1.08; 95% CI, 1.02-1.15), insulin treatment (OR, 13.88; 95% CI, 2.95-65.28), and long-term antiviral treatment (OR, 4.86; 95% CI, 2.40-9.85).
• MASLD was more common in patients who were on antiviral treatment than in those who were untreated (49.2% vs 44.2%; P = .046). Screening practices for MASLD varied, with 68.4% of centres screened all patients with chronic hepatitis B and 21.1% screened only those with metabolic syndrome and/or steatosis on ultrasound and abnormal liver function tests.

IN PRACTICE:

“The results from our study might genuinely mirror the increase in MASLD cases in Europe that is also reflected in patients with CHB [chronic hepatitis B],” the authors wrote.

SOURCE:

This study was led by Maria Kalafateli and Roberta Forlano, Imperial College London, London, England. It was published online on July 01, 2025, in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

This study was retrospective in nature with missing data from some participating centres. The use of liver stiffness measurement to define advanced fibrosis, despite its modest predictive performance, could have influenced the results. The short duration of longitudinal data collection limited the ability to observe long-term effects of MASLD on chronic hepatitis B outcomes.

DISCLOSURES:

The authors declared having no conflicts of interest. This study did not receive any specific funding, but the Division of Digestive Diseases at Imperial College London received financial support from the National Institute for Health and Care Research Imperial Biomedical Research Centre and one author was a recipient of a Medical Research Council Clinician Scientist award.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.