Association between hepatitis B and metabolic syndrome: Current state of the art

Table 1 Association between chronic hepatitis B virus infection and metabolic syndrome

Ref. (Region)	Race	Study design	HBV patients/controls	Prevalence MS in HBV patients/controls	Result/statistical significance
Jan et al[6] (Taiwan)	Asian	Population-based	5995 HBV patients/ 47533 controls	8.0%/10.9%	Inverse correlation between MS and HBV infection
		Cross-sectional study			OR = 0.72 (0.65-0.79); P < 0.001
					aOR = 0.84 (0.76-0.93); P < 0.0011
Luo et al[7] (China)	Asian	Cross-sectional study	858 HBV patients/ 6579 controls	5.9%/8.8%	Inverse correlation between MS and HBV infection
					OR = 0.65 (0.48-0.88); P = 0.003
Wong et al[8] (Hong Kong, China)	Asian	Case series	91 HBV patients/ 922 controls	11.0%/20.2%	Inverse correlation between MS and HBV infection; P = 0.034
Li et al[9] (Taiwan)	Asian	Case series	3408 HBV patients/ 22897 controls	13.4%/14.0%	No correlation between MS and HBV infection
Chung et al[10] (South Korea)	Asian	Cross-sectional study	521 HBV patients/ 8953 controls	19.5%/20.8% in men	Inverse correlation between MS and HBV infection in men only after adjustation
				14.3%/13.7% in women
					OR = 0.92 (0.72-1.17); P = 0.492; NS
					aOR = 0.75 (0.57-0.98); P = 0.033b
					No correlation between MS and HBV infection in women
					OR = 1.05 (0.56-1.96) NS
					aOR = 0.80 (0.38-1.66); P = 0.545; NS2
Jinjuvadia et al[11] (United States)	Caucasian (80%)	Large population database	593 594 HBV patients/7280620 patients with past exposure to hepatitis B/138283905 controls	10.4%/25.6% total	Inverse correlation between MS and HBV infection in all patients
					OR = 0.34 (0.13-0.87)
					aOR = 0.32 (0.12-0-82); P = 0.019c
					Inverse correlation between MS and HBV infection in men
					OR = 0.13 (0.04-0.44)
					aOR = 0.14 (0.04-0.55)3
					No correlation between MS and HBV infection in women
					OR = 0.89 (0.30-2.65)
					aOR = 0.73 (0.22-2.46)3
Zhou et al[12] (China)	Asian	Retrospective cohort study	480 HBV patients/ 496 controls	24.5%/10.5%	Correlation between MS and HBV infection
					OR = 2.46 (1.77-3.41)
					aOR = 2.27 (1.52-3.38)4
Jarčuška et al[13] (Slovakia)	Caucasian + Roma	Cross-sectional study	66 HBV patients/ 789 controls	24.6%/24.7%	No correlation between MS and HBV infection; P = 0.561; NS
Janicko et al[14] (Slovakia)	Roma	Cross-sectional study	55 HBV patients/ 387 controls	27.8%/29.6%	No correlation between MS and HBV infection; P = 0.785; NS
Choi et al[15] (South Korea)	Asian	Population database	209 HBV patients/ 4899 controls	23.4%/31.5% in men	Inverse correlation between MS and HBV infection in men only after adjustation
				18.6%/23.7% in women
					OR = 0.66 (0.42-1.05); P = 0.079; NS
					OR = 0.61 (0.375-0.998); P = 0.0495
					No correlation between MS and HBV infection in women
					OR = 0.74 (0.44-1.22); P = 0.235; NS
					aOR = 0.70 (0.40-1.21); P = 0.197; NS5

¹Adjusted for age and sex;

²Adjusted for age, body mass index, alaninaminotranferase, alcohol intake, smoking, exercise, family income and educational status;

³Adjusted for age, sex, race, smoking and alcohol status;

⁴Adjusted for age, gender, smoking, passive smoking, alcohol consumption, high-energy food intake, fresh fruit and vegetable intake, physical activity;

⁵Adjusted for age, location, smoking habits, alcohol consumption, exercise habits, income status, and education levels. MS: Metabolic syndrome; NS: Not significant; HBV: Hepatitis B virus; OR: Odds ration; aOR: Adjusted odds ratio.

Table 2 Levels of lipoproteins in chronic hepatitis B virus patients and controls

Ref.	Laboratory parameter	HBV patients vs controls statistical significance	HBV patients vs controls
Su et al[19]	Total cholesterol	P < 0.05	181.7 ± 29.8 mg/dL vs 186.8 ± 33.3 mg/dL
	LDL-C	NS	108.7 ± 25.9 mg/dL vs 109.4 ± 28.6 mg/dL
	HDL-C	P < 0.01	53.4 ± 11.6 mg/dL vs 56.5 ± 13.5 mg/dL
	TG	NS	99.2 ± 54.0 mg/dL vs 102.7 ± 57.6 mg/dL
Jan et al[6]	TG	OR = 0.64 (0.60-0.69)
	HDL-C	OR = 0.89 (0.80-0.99)
Luo et al[7]	TG	OR = 0.62 (0.53-0.72); P = 0.002
	HDL-C	NS
Chen et al[20]	Cholesterol	P < 0.001
	TG	P < 0.001
Wong et al[8]	Total cholesterol	P = 0.004	4.9 ± 0.8 mmol/L vs 5.2 ± 1.0 mmol/L
	LDL-C	NS	2.9 ± 0.8 mmol/L vs 3.0 ± 0.9 mmol/L
	HDL-C	NS	1.5 ± 0.4 mmol/L vs 1.5 ± 0.4 mmol/L
	TG	P = 0.027	1.0 (0.1-2.9) mmol/L vs 1.1 (0.3-21.3) mmol/L
Hsu et al[21]	LDL-C	NS
	HDL-C	aOR = 0.004 (0.001-0.017); P < 0.0011
	TG	aOR = 0.107 (0.054-0.213); P < 0.0011
Li et al[9]	Total cholesterol ≤ 45 yr in women	P < 0.001	178 mg/dL vs 174 mg/dL
	Total cholesterol > 45 yr in women	P = 0.040	201 mg/dL vs 205 mg/dL
	LDL-C ≤ 45 yr in women	P = 0.040	103.5 mg/dL vs 101.2 mg/dL
	LDL-C > 45 yr in women	NS	123.6 mg/dL vs 126.8 mg/dL
	HDL-C ≤ 45 yr in women	P < 0.001	63.3 mg/dL vs 61.5 mg/dL
	HDL-C > 45 yr in women	NS	60.1 mg/dL vs 59.4 mg/dL
	TG ≤ 45 yr in women	NS	67 mg/dL vs 67 mg/dL
	TG > 45 yr in women	P < 0.001	85 mg/dL vs 93 mg/dL
	Total cholesterol ≤ 45 yr in men	NS	183 mg/dL vs 182 mg/dL
	Total cholesterol > 45 yr in men	P < 0.001	188 mg/dL vs 197 mg/dL
	LDL-C ≤ 45 yr in men	NS	49.8 mg/dL vs 49.7 mg/dL
	LDL-C > 45 yr in men	P < 0.001	117.6 mg/dL vs 123 mg/dL
	HDL-C ≤ 45 yr in men	NS	51 mg/dL vs 51 mg/dL
	HDL-C > 45 yr in men	NS	49.8 mg/dL vs 49.7 mg/dL
	TG ≤ 45 yr in men	P = 0.017	100 mg/dL vs 104 mg/dL
	TG > 45 yr in men	P < 0.001	102 mg/dL vs 116 mg/dL
Liu et al[22]	Total cholesterol	P < 0.05	193 ± 36 mg/dL vs 197 ± 36 mg/dL
	LDL-C	P < 0.05	124 ± 31 mg/dL vs 126 ± 36 mg/dL
	HDL-C	NS	53 ± 16 mg/dL vs 53 ± 16 mg/L
	TG	NS	126 ± 129 mg/dL vs 131 ± 87 mg/dL
Chung et al[10]	TG in men	P < 0.001	4.59 ± 0.48 mg/dL vs 4.75 ± 0.52 mg/dL
	HDL-C in men	P = 0.039	3.81 ± 0.26 mg/dL vs 3.84 ± 0.25 mg/dL
	TG in women	NS	4.45 ± 0.30 mg/dL vs 4.50 ± 0.50 mg/dL
	HDL-C in women	NS	4.01 ± 0.20 mg/dL vs 3.97 ± 0.24 mg/dL
Jinjuvadia et al[11]	TG	NS (total, in men, in women)
	HDL-C (total)	OR = 0.37 (0.15-0.91)
	HDL-C in men	NS
	HDL C in women	OR = 0.26 (0.07-0.93)
Jarčuška et al[13]	Total cholesterol	P = 0.001	4.54 ± 0.84 mmol/L vs 5.00 ± 0.99 mmol/L
	LDL –C	P = 0.001	2.29 ± 0.58 mmol/L vs 2.60 ± 0.68 mmol/L
	HDL-C	NS	1.19 ± 0.35 mmol/L vs 1.19 ± 0.41mmol/L
	TG	NS	1.11 ± 0.59 mmol/L vs 1.31 ± 0.91 mmol/L
	ApoB100	P = 0.013	0.71 ± 0.21 g/L vs 0.77 ± 0.23 g/L
Janicko et al[14]	Total cholesterol	P = 0.035	4.45 ± 1.21 mmol/L vs 4.71 ± 1.23 mmol/L
	LDL –C	NS	2.20 ± 0.88 mmol/L vs 2.50 ± 0.90 mmol/L
	HDL-C	NS	1.10 ± 0.53 mmol/L vs 1.10 ± 0.36 mmol/L
	TG	NS	1.02 ± 1.56 mmol/L vs 1.15 ± 1.75 mmol/L
	ApoB100	P = 0.025	0.66 ± 0.26 g/L vs 0.74 ± 0.29 g/L
Choi et al[15]	TG in men	OR = 0.63 (0.40-0.99); P = 0.043
	HDL-C in men	NS
	TG in women	OR = 0.34 (0.17-0.69); P = 0.003
	HDL-C in women	NS

¹Multivariate analyses using logistic regression, the status of HBsAg positivity as the dependent variable, age, sex, body mass index, serum TG, LDL-C, HDL-C and alaninamonotransferase level as independent variables were performed. NS: Not significant; HBV: Hepatitis B virus; OR: Odds ration; TG: triglycerides; HDL-C: High density lipoproteins; LDL-C: Lowe density lipoproteins; ApoB100: Apolipoprotein B100; aOR: Adjusted odds ratio.