Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection

Background and aims: Steatosis and insulin resistance (IR) are the major disease modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated these features in patients with chronic hepatitis B (CHB). We aimed to assess the prevalence and the factors related to steatosis and IR in CHB patients, compared with CHC subjects, and to evaluate the potential association between these features and fibrosis severity. Material and methods: One hundred and seventy consecutive patients with CHB (28 HBeAg positive, 142 HBeAg negative), were evaluated using liver biopsy and metabolic measurements and matched for sex, age and body mass index with 170 genotype 1 CHC patients. IR was defined if HOMA‐IR>2.7. All biopsies were scored for grading and staging by Scheuer's score, and the steatosis was considered significant if ≥10%. Results: The prevalence of significant steatosis was similar in both CHB and CHC patients (31 vs. 38%; P=0.14). IR rate was significantly higher in CHC than in CHB patients (42 vs. 26%; P=0.002). Severe fibrosis (F3–F4), at multivariate analysis, was independently associated with older age (OR 1.050, 95% CI 1.009–1.093), steatosis >10% (OR 4.375, 95% CI 1.749–10.943), and moderate–severe necroinflammatory activity (OR 8.187, 95% CI 2.103–31.875), regardless of HBeAg status, in CHB patients, and with older age (OR 1.080, 95% CI 1.028–1.136), IR (OR 2.640, 95% CI 1.110–6.281), steatosis >10% (OR 3.375, 95% CI 1.394–8.171), and moderate–severe necroinflammatory activity (OR 8.988, 95% CI 1.853–43.593) in CHC patients. Conclusions: CHB patients had high steatosis prevalence, similar to CHC controls, but lower IR rate. Both steatosis and IR in CHC, and only steatosis in CHB, are independently associated with fibrosis severity.