Prevalence of cardiometabolic co-morbidities in patients with vs persons without chronic hepatitis B: The FitLiver cohort study

Table 1 Baseline demographic characteristics of patients with chronic hepatitis B and a comparison group without chronic hepatitis B, matched on age, sex, body mass index, and country-of-birth, n (%)

	All participants	Chronic hepatitis B	Comparison group	P value
Participants, n	147	98	49
Age, years (range)	45 (19-78)	44 (25-74)	46 (19-78)	0.15
Sex, female	74 (50)	50 (51)	24 (49)	0.86
Country of birth				0.30
Denmark	20 (14)	12 (12)	8 (16)
Eastern Europe	9 (6)	5 (5)	4 (8)
Turkey	28 (19)	21 (21)	7 (14)
MENA region	19 (13)	9 (9)	10 (20)
Sub-Saharan Africa	11 (7)	7 (7)	4 (8)
Asia	58 (39)	43 (44)	15 (31)
South America	2 (1)	1 (1)	1 (2)
Highest level of education				0.50
Primary school	17 (12)	14 (14)	3 (6)
High school	10 (7)	6 (6)	4 (8)
Vocational education	31 (21)	20 (20)	11 (22)
Academic higher education	85 (58)	54 (55)	31 (63)
Employment				0.29
Student	11 (7)	7 (7)	4 (8)
Employed/self-employed	109 (74)	68 (69)	41 (84)
Unemployed	10 (7)	8 (8)	2 (4)
Retired	14 (10)	12 (12)	2 (4)
Relationship status
Married or with a partner	111 (76)	79 (80)	32 (65)	< 0.05
Substance intake
Alcohol use currently	76 (52)	42 (43)	34 (69)	< 0.05
Smoking ever	61 (41)	41 (42)	20 (41)	1.00
Drug-use ever	12 (8)	7 (7)	5 (10)	0.53

The groups were compared using Fisher’s exact test. A P value of < 0.05 is considered statistically significant. MENA: Middle East and Northern Africa.

Table 2 Baseline clinical characteristics of patients with chronic hepatitis B and a comparison group without chronic hepatitis B matched on age, sex, body mass index, and country-of-birth, n (%)

	All participants	Chronic hepatitis B	Comparison group	P value
Participants, n	147	98	49
Body anthropometrics
Body weight, mean (± SD), kg	74.6 (± 17.4)	74.5 (± 17.7)	74.8 (± 16.8)	0.94
BMI, mean (± SD), kg/m2	26.2 (± 4.9)	26.3 (± 5.16)	26.1 (± 4.43)	0.83
Waist-to-hip ratio (WHR), mean (± SD)	0.88 (± 0.09)	0.88 (± 0.09)	0.88 (± 0.08)	1.00
Total body fat, mean (± SD), %	32.6 (± 9.5)	32.9 (± 9.7)	32.0 (± 9.3)	0.59
Total lean body mass, median (IQR), kg	45.6 (17.5)	46.5 (18.3)	45.1 (13.3)	0.48
Abdominal obesity by WHR	85 (58)	56 (57)	29 (59)	0.86
Liver parameters
ALT, median (IQR), U/L	27 (17)	28 (18)	24 (13)	< 0.05
Viral load, median (IQR), IU/mL	-	310 (2020)	-
Anti-HDV positive	-	1 (1)	-
HBeAg positive	-	5 (5)	-
Anti-HBc positive	106 (72)	98 (100)	8 (16)	< 0.05a
Anti-HBs positive, level ≥ 10 IU/L	28 (19)	1 (1)	27 (55)	< 0.05a
Fib-4 score, median (IQR),	0.89 (0.53)	0.89 (0.52)	0.87 (0.58)	0.84
TE-score, median (IQR), kPa	4.5 (1.6)	4.7 (1.5)	4.4 (1.3)	< 0.05
CAP, mean (± SD), dB/m	250 (± 66)	248 (± 64)	255 (± 69)	0.52
Hepatic steatosis, CAP ≥ 248	73 (50)	47 (48)	26 (53)	0.60
Cardiovascular parameters
Cholesterol, mmol/L	4.8 (1.1)	4.7 (1.1)	4.9 (1.1)	0.29
Hypercholesterolemia by cholesterol > 5 mmol/L	52 (35)	30 (31)	22 (45)	0.10
Triglycerides, median (IQR), mmol/L	1.0 (0.7)	1.0 (0.6)	1.1 (0.8)	0.43
LDL-cholesterol, median (IQR), mmol/L	3.0 (1.0)	2.8 (0.9)	3.2 (1.3)	0.13
HDL-cholesterol, median (IQR), median (IQR), mmol/L	1.3 (0.6)	1.3 (0.5)	1.4 (0.5)	0.12
Systolic blood pressure, mean (± SD), mmHg	119 (± 15)	118 (± 15)	122 (± 15)	0.13
Diastolic blood pressure, mean (± SD), mmHg	75 (± 10)	75 (± 11)	75 (± 9)	0.95
Glucose metabolism
HbA1c, median (IQR), mmol/L	36 (6)	36 (6)	38 (5)	< 0.05
HbA1c ≥ 48 mmol/L	6 (4)	0	6 (12)	< 0.05a
Fasting glucose, median (IQR), mmol/L	4.9 (0.8)	4.9 (0.6)	5.1 (0.8)	< 0.05
Fasting insulin pmol/L	65 (58)	66 (53)	61 (79)	0.73
2-hour glucose, median (IQR), mmol/L	6.8 (2.2)	6.8 (1.8)	7.1 (3.8)	0.63
OGTT 2h glucose ≥ 11.1	17 (12)	8 (8)	9 (18)	0.10
OGTT glucose AUC, median (IQR), mmol/L/minute	899 (242)	879 (233)	905 (365)	0.53
OGTT Insulin AUC, median (IQR), pmol/L/minute	56295 (49073)	66311 (54818)	45952 (33450)	< 0.05
Matsuda Index, median (IQR)	3.7 (3.5)	3.6 (2.8)	3.8 (4.5)	0.57
HOMA-IR, median (IQR)	1.2 (1.1)	1.3 (1.0)	1.2 (1.5)	0.81
Known cardiometabolic co-morbidity
Hypercholesterolemia	18 (12)	9 (9)	7 (15)	0.40
Hypertension	16 (11)	11 (11)	7 (15)	0.60
Type 2 diabetes	6 (4)	0 (0)	6 (12)	< 0.05a
Current medication
Lipid-lowering medicine	14 (10)	8 (8)	6 (12)	0.55
Antihypertensive medication	19 (13)	12 (12)	7 (14)	0.79
Anti-diabetic medicine	6 (4)	1 (1)	5 (10)	< 0.05
Antiviral medicine	23 (16)	22 (22)	1 (2)	< 0.05a
Collectively assessed cardiometabolic co-morbidity
Obesity	112 (76)	75 (77)	37 (76)	1.00
MASLD	69 (47)	44 (45)	25 (51)	0.48
Hypercholesterolemia	65 (44)	37 (38)	28 (57)	< 0.05
Hypertension	42 (29)	25 (26)	17 (35)	0.25
Type 2 diabetes	17 (12)	8 (8)	9 (18)	0.10

^aP < 0.05 indicates statistical significance after Bonferroni correction. A P value of < 0.05 is considered to show a trend.

According to normality distribution, continuous data is presented in mean (± SD) or median (interquartile range). Quantitative outcome variables were compared using the independent t-test and Mann-Whitney U test according to normality distribution. Fisher’s exact test was used to analyze categorical data. Definitions of collectively assessed cardiometabolic co-morbidity: Obesity is defined as body mass index > 25 or abnormal waist-to-hip ratio; metabolic dysfunction-associated steatotic liver disease; hypercholesterolemia as total cholesterol > 5 mmol/L or use of statins; hypertension is defined as measured systolic blood pressure of ≥ 135 mmHg and or a diastolic blood pressure ≥ 85 mmHg and or use of antihypertensive medication; type 2 diabetes (T2D) is defined as blood glucose > 11 mmol/L after a 2-hour oral glucose tolerance test, or hemoglobin A1c > 48 or use of antidiabetic medicine intended to treat T2D. ALT: Alanine aminotransferase; AUC: Area under the curve; BMI: Body mass index; CAP: Controlled attenuation parameter; FIB-4: Fibrosis index 4 factors; HbA1c: Hemoglobin A1c; HBeAg: Hepatitis B e antigen; HBV: Hepatitis B virus; HDL: High-density lipoprotein; Anti-HBc: Hepatitis B core antibodies; Anti-HBs: Hepatitis B surface antibodies; Anti-HDV: Hepatitis D virus antibodies; IQR: Interquartile range; LDL: Low-density lipoprotein; MASLD: Metabolic dysfunction-associated steatotic liver disease; TE: Transient elastography; WHR: Waist-to-hip ratio.

Table 3 Physical activity of patients with chronic hepatitis B and a comparison group from the general population matched on age, sex, body mass index, and country-of-birth

	All participants	Chronic hepatitis B	Comparison group	P value
Participants, n	147	98	49
VO2max, mean (± SD), mL/kg/minute	28.0 (± 7.7)	26.9 (± 7.5)	30.2 (± 7.6)	< 0.05
Self-assessed physical activity
MVPA, median (IQR), minute/week	120 (353)	68 (262)	188 (406)	< 0.05
Walking activity, mean (± SD), minute/week	243 (± 548)	290 (± 538)	180 (± 364)	0.10
Sitting time, mean (± SD), minute/week	2100 (± 2047)	1680 (± 1470)	2625 (± 1680)	< 0.05a
Measured physical activity
MVPA, median (IQR), minute/week	388 (230)	357 (257)	424 (204)	0.23
Walking activity, mean (± SD), minute/week	624 (± 232)	628 (± 248)	615 (± 201)	0.76
Sitting time, mean (± SD), minute/week	3471 (± 981)	3536 (± 992)	3345 (± 957)	0.27
Sedentary time, median (IQR), minute/week	8399 (656)	8449 (735)	8393 (567)	0.65

^aP < 0.05 indicates statistical significance after Bonferroni correction. A P value of < 0.05 is considered to show a trend.

According to normality distribution, data is given in mean (± SD) or median (interquartile range). Quantitative outcome variables were compared using the independent t-test and Mann-Whitney U test according to normality distribution. Fisher’s exact test was used to analyze categorical data. IQR: Interquartile range; MVPA: Moderate-to-vigorous physical activity; VO₂max: Maximal oxygen consumption.