Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2025; 17(1): 97797
Published online Jan 27, 2025. doi: 10.4254/wjh.v17.i1.97797
Prevalence of cardiometabolic co-morbidities in patients with vs persons without chronic hepatitis B: The FitLiver cohort study
Sofie Jespersen, Asmita Fritt-Rasmussen, Sten Madsbad, Bente K Pedersen, Rikke Krogh-Madsen, Nina Weis
Sofie Jespersen, Rikke Krogh-Madsen, Nina Weis, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
Sofie Jespersen, Asmita Fritt-Rasmussen, Bente K Pedersen, Rikke Krogh-Madsen, Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Denmark
Sten Madsbad, Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
Author contributions: Jespersen S, Weis N, Pedersen BK, and Krogh-Madsen R conceived the study; Jespersen S, Krogh-Madsen R, Weis N, Pedersen BK, and Madsbad S contributed to protocol development and study design; Jespersen S and Weis N screened for eligible patients and included them; Jespersen S and Fritt-Rasmussen A integrated and quality-checked the data; Jespersen S and Fritt-Rasmussen A performed the experiments and collected the data; Jespersen S performed the statistical analyses; Jespersen S wrote the first article draft; All authors read the manuscript, critically revised it for important intellectual content, and approved the final version.
Supported by The Centre for Physical Activity Research (CFAS), TrygFonden, No. 125132; and The Beckett Foundation, No. 22-2-9924.
Institutional review board statement: This study was approved by the Regional Committee under the Danish National Committee on Health Research Ethics (J.no. H-22055480), is regulated by the Danish Data Protection Agency (registration P-2023-24) and was carried out in accordance with the Helsinki Declaration for ethics standards in human trials.
Clinical trial registration statement: This study was not registered in a clinical trials registry. As an observational, prospective cohort study, it does not meet the typical criteria for clinical trial registration, which generally applies to interventional studies such as randomized controlled trials. However, we have adhered to relevant ethical guidelines and reporting standards, such as the STROBE guidelines, to ensure the rigorous conduct and transparent reporting of our research.
Informed consent statement: All participants signed an informed consent form prior to their inclusion in the study. The consent process included a thorough explanation of the study’s purpose, procedures, potential risks, and benefits. Participants were informed of their right to withdraw from the study at any time without any negative consequences. Additionally, the confidentiality of their data was assured, and all data were anonymized to protect participant privacy.
Conflict-of-interest statement: Weis N has been a clinical investigator for Merck, Sharp and Dohme. The authors declare no conflicts of interest.
Data sharing statement: The public release of raw data is restricted by Denmark's national legislation, specifically the Data Protection Act § 10 and the Data Disclosure Proclamation Act. According to these laws, we are only permitted to provide pseudonymized data to the Journal after obtaining approval from the Data Protection Authorities (Data Protection Act § 10, section 3, nr. 3). Interested parties, including reviewers, can request access to the data; however, such access is contingent upon approval from the Danish Data Protection Agency for the transfer of data from the Capital Region to the Journal. Suppose a journal intends to share pseudonymized data with others. In that case, it must establish a suitable legal basis for doing so and ensure that the data are used exclusively for scientific research purposes.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sofie Jespersen, MD, PhD, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, Hvidovre 2650, Denmark. sofie.dikeledi.kold.jespersen@regionh.dk
Received: June 8, 2024
Revised: August 29, 2024
Accepted: September 19, 2024
Published online: January 27, 2025
Processing time: 211 Days and 11.2 Hours
Abstract
BACKGROUND

Chronic hepatitis B (CHB) affects > 300 million people worldwide. The combination of CHB and cardiometabolic co-morbidities increases the risk of liver-related morbidity and mortality. However, international guidelines for CHB treatment do not provide recommendations for follow-up examinations or treatment of patients with CHB and cardiometabolic comorbidities. In studies investigating cardiometabolic co-morbidity in patients with CHB, inconsistent findings have been observed, and both lower and higher prevalence of cardiometabolic co-morbidities compared to the general population have been reported. It is unclear whether patients with CHB living in Denmark have an increased prevalence of cardiometabolic co-morbidities.

AIM

To investigate the prevalence of cardiometabolic comorbidities in patients with CHB and matched non-CHB comparison group.

METHODS

We examined patients with CHB and age-, sex-, body mass index (BMI)-, and country-of-birth matched comparison group. Defining cardiometabolic co-morbidity: Obesity (BMI > 25 kg/m2/abnormal waist-to-hip ratio), metabolic dysfunction-associated steatotic liver disease (MASLD), hypercholesterolemia (total-cholesterol > 5 mmol/L/statin use), hypertension (systolic ≥ 135 mmHg/ diastolic ≥ 85 mmHg/antihypertensive medication) and type 2 diabetes (T2D) (2-hour oral glucose tolerance test glucose > 11.1 mmol/L/HbA1c > 48 mmol/mol/ antidiabetic medication). Physical activity was evaluated using maximal oxygen consumption (VO2max), activity monitors, and a questionnaire.

RESULTS

We included 98 patients with CHB and 49 persons in the comparison group. The two groups were well-matched, showing no significant differences in age, sex, BMI, country-of-birth, education, or employment. Among patients with CHB, the following prevalence of cardiometabolic co-morbidity was found: 77% were obese, 45% had MASLD, 38% had hypercholesterolemia, 26% had hypertension, and 7% had T2D, which did not differ significantly from the comparison group, apart from lower prevalence of hemoglobin A1c (HbA1c) ≥ 48 mmol/L or known T2D. Both groups had low VO2max of 27 mL/kg/minute in the patients with CHB and 30 mL/kg/minute in the comparison group, and the patients with CHB had a shorter self-assessed sitting time.

CONCLUSION

The patients with CHB and the comparison group were well-matched and had a similar prevalence of cardiometabolic comorbidities. Furthermore, both groups had low levels of physical fitness.

Keywords: Viral hepatitis B; Diabetes; Metabolic dysfunction-associated steatotic liver disease; Hypertension; Hypercholesterolemia; Obesity; Physical activity

Core Tip: This study assessed the prevalence of cardiometabolic comorbidities in patients with chronic hepatitis B (CHB) compared with a matched non-CHB group in Denmark. Both groups demonstrated similar prevalence of obesity, metabolic dysfunction-associated steatotic liver disease, hypercholesterolemia, hypertension, and type 2 diabetes (T2D). Notably, patients with CHB had a lower prevalence of hemoglobin A1c ≥ 48 mmol/mol or known T2D. Additionally, both groups exhibited low levels of physical fitness. This highlights the need for tailored management strategies to address cardiometabolic health issues in patients with CHB despite the comparable prevalence of comorbidities in the general population.