Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B

Table 1 Main characteristics of the patients with chronic hepatitis B according to sex (n = 105)

Variables	Total (n = 105)	Male (n = 61)	Female (n = 44)	P value
Demographic
Age (yr)1	48.5 ± 12.0	48.9 ± 12.9	48.0 ± 10.7	0.69
HBV infection
HBeAg negative n (%)	94 (89.5)	52 (85.2)	42 (95.5)	0.12
HBeAg positive n (%)	11 (10.5)	9 (14.8)	2 (4.5)
HBV-DNA log10 (IU)/mL2	3.23 (2.59; 4.33)	3.66 (2.75; 5.12)	2.97 (2.53; 3.70)	0.05
Phases of HBV infection3
HBeAg-positive or -negative HBV chronic infection n (%)	44 (41.9)	19 (31.2)	25 (56.8)	0.008
HBeAg-positive or -negative chronic hepatitis B n (%)	61 (58.1)	42 (68.8)	19 (43.2)
Time of HBV diagnosis (years)2	13.0 (5.0; 19.0)	19.5 (15.0; 24.0)	8.0 (4.0; 15.0)	0.17
Antiviral therapy
Entecavir n (%)	35 (33.3)	29 (47.6)	6 (13.6)	0.009
Tenofovir disoproxil fumarate n (%)	26 (24.8)	13 (21.3)	13 (29.6)
Time of antiviral treatment (months)2	36.0 (12.0; 60.0)	36.0 (12.0; 60.0)	39.0 (12.0; 49.5)	0.58
Stage of liver disease
Without cirrhosis n (%)	80 (76.2)	37 (60.7)	43 (97.7)	< 0.001
Compensated cirrhosis n (%)	25 (23.8)	24 (39.3)	1 (2.3)
Child-Pugh-Turcotte score (A5/A6)	19/6	18/6	1/0
Biochemical parameters2
Serum albumin, g/dL	4.4 (4.1; 4.6)	4.5 (4.2; 4.7)	4.2 (4.1; 4.5)	0.02
Clinical and metabolic abnormalities n (%)
Blood hypertension	34 (32.4)	20 (32.8)	14 (31.8)	0.92
Diabetes mellitus	11 (10.5)	9 (14.8)	2 (4.5)	0.12
Dyslipidaemia	19 (18.1)	11 (18.0)	8 (18.2)	0.98
Overweight/obesity4	60 (57.1)	31 (50.8)	29 (65.9)	0.12
Metabolic syndrome5	19 (18.1)	10 (16.4)	9 (20.5)	0.59
Hepatic steatosis	40 (38.1)	27 (44.3)	13 (29.6)	0.13
Metabolic associated fatty liver disease6	29 (27.6)	18 (29.5)	11 (25.0)	0.61
Polypharmacy7	10 (9.5)	6 (9.8)	4 (9.1)	0.9
Lifestyle data n (%)
Low IPAQ (<600 met-min/week)	65 (61.9)	38 (62.3)	27 (61.4)	0.92
Current alcohol consumption8	7 (6.7)	4 (6.6)	3 (6.8)	1
Risk drinking consumption9	3 (2.9)	2 (3.3)	1 (2.3)	1

¹mean ± SD.

²Median [(interquartile range), 25^th - 75^th percentile].

³According to guidance The European Association for the Study of the Liver[24].

⁴Body mass index (BMI) > 25 (< 60 yr) and BMI > 27 (> 60 yr).

⁵The International Diabetes Federation worldwide definition of the metabolic syndrome[28].

⁶Metabolic associated fatty liver disease according to an international expert consensus statement[21].

⁷Defined as regular use of at least five medications.

⁸The median [(interquartile range), 25^th - 75^th percentile] current alcohol intake per day was 7.9 g (2.7-19.0) and 5.0 g (0.6-10.5) for men and women, respectively.

⁹> 30 g per day for men and > 20 g per day for women.

n: Number of subjects; HBV: Hepatitis B virus; HBeAg: Hepatitis B e-antigen; ALT: Alanine aminotransferase; γ-GT: γ-glutamyltranspeptidase; IPAQ: International Physical Activity Questionnaire (normal: ≥ 600 METs-min/wk). The asymptotic Pearson’s χ² test was used to compare categorical variables. The t test and Mann-Whitney U test were used for comparison of normal and nonnormal continuous variables: Respectively.

Table 2 Univariate and multivariable analyses of variables associated with skeletal muscle abnormalities and function in 105 patients with chronic hepatitis B

Variables	Univariate analysis					Multivariable analysis
	Low ALMBMI
	Present n = 22	Absent n = 83	OR	95%CI	P value	OR	95%CI	P value
Male/Female n (%)	13 (59.1)/9 (40.9)	48 (57.8)/35 (42.2)	1.05	0.41-2.73	0.92	-	-	-
Age > 50 yr	13 (59.1)	33 (39.8)	2.19	0.84-5.70	0.1	1.03	0.98-1.08	0.2
High ABSI (m11/6.kg−2/3)	10 (45.5)	16 (19.3)	3.49	1.29-9.50	0.01	3.53	1.18-10.60	0.03
Compensated cirrhosis	9 (40.9)	16 (19.3)	2.9	1.06-7.96	0.03	1.64	0.51-5.27	0.41
MAFLD	11 (50.0)	18 (21.7)	3.61	1.35-9.68	0.008	3.81	1.30-11.19	0.02
Low IPAQ (< 600 met-min/wk)	19 (86.4)	46 (55.4)	5.09	1.40-18.55	0.01	3.13	1.17-8.32	0.02
Polypharmacy1	4 (18.2)	6 (7.2)	2.85	0.73-11.17	0.21	-	-	-
Variables	Low HGS
	Present n = 22	Absent n = 83	OR	95%CI	P value	OR	95%CI	P value
Male/Female n (%)	12 (54.5)/10 (45.5)	49 (59.0)/34 (41.0)	0.83	0.32-2.14	0.7	-	-	-
Age > 50 years	11 (50.0)	35 (42.2)	1.37	0.58-3.51	0.51	-	-	-
High ABSI (m11/6.kg−2/3)	10 (45.5)	16 (19.3)	3.49	1.29-9.50	0.01	3.54	1.26-9.89	0.02
Compensated cirrhosis	8 (36.4)	17 (20.5)	2.22	0.80-6.15	0.12	1.45	0.46-4.55	0.53
MAFLD	10 (45.5)	19 (22.9)	2.81	1.05-7.50	0.04	2.85	1.02-7.91	0.04
Low IPAQ (< 600 met-min/wk)	13 (59.1)	52 (62.7)	0.86	0.33-2.25	0.76	-	-	-
Polypharmacy1	5 (22.7)	5 (6.0)	4.59	1.19-17.63	0.02	3.13	0.74-13.22	0.12
Variables	Low physical performance
	Present n = 31	Absent n = 74	OR	95%CI	P value	OR	95%CI	P value
Male/Female n (%)	17 (54.8)/14 (45.2)	44 (59.5)/30 (40.5)	0.83	0.36-1.93	0.66	-	-	-
Age > 50 years	21 (67.7)	61 (82.4)	0.45	0.17-1.17	0.1	0.69	0.46-1.05	0.08
High ABSI (m11/6.kg−2/3)	7 (22.6)	19 (25.7)	0.84	0.32-2.27	0.74	-	-	-
Compensated cirrhosis	6 (19.4)	19 (25.7)	0.69	0.25-1.96	0.49	-	-	-
MAFLD	9 (29.0)	20 (27.0)	1.1	0.44-2.80	0.83	-	-	-
Low IPAQ (< 600 met-min/wk)	21 (67.7)	44 (59.5)	1.43	0.59-3.47	0.43	-	-	-
Polypharmacy1	6 (19.4)	4 (5.4)	4.2	1.09-16.13	0.06	5.69	1.38-23.44	0.02

¹Defined as regular use of at least five medications.

n: Number of patients; ALM_BMI: Low appendicular lean mass adjusted by body mass index; ABSI: A Body Shape Index; MAFLD: (Metabolic associated fatty liver disease) according to an international expert consensus statement [21]; IPAQ: International Physical Activity Questionnaire (normal: ≥ 600 METs-min/wk); HGS: Hand grip strength.