Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2021; 12(11): 1928-1941
Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1928
Role of hepatitis A virus in diabetes mellitus
James Lin, Horng-Yih Ou, Rudruidee Karnchanasorn, Raynald Samoa, Lee-Ming Chuang, Ken C Chiu
James Lin, Department of Gastroenterology, City of Hope National Medical Center, Duarte, CA 91010, United States
Horng-Yih Ou, Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng-Kung University Medical College and Hospital, Tainan 700, Taiwan
Rudruidee Karnchanasorn, Division of Endocrinology, Metabolism and Genetics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
Raynald Samoa, Department of Clinical Diabetes, Endocrinology, and Metabolism, Diabetes and Metabolism Research Institute, City of Hope National Medical Center, Duarte, CA 91010, United States
Raynald Samoa, Ken C Chiu, Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, United States of America
Lee-Ming Chuang, Department of Internal Medicine, National Taiwan University Hospital, Taipei 102, Taiwan
Lee-Ming Chuang, Graduate Institute of Preventive Medicine, School of Public Health, Taipei 102, Taiwan
Author contributions: Chiu KC, Lin J, and Chuang L-M conceived and designed the study; Karnchanasorn R and Ou HY obtained data under the direction of Chiu KC, Lin J, and Chuang LM; Chiu KC, and Samoa R reviewed the integrity of data; All authors had full access to all the data in the study; Karnchanasorn R, Chiu KC, and Chuang LM performed statistical analyses and interpreted data; Chiu KC and Lin J drafted the paper; All authors revised the paper for important intellectual content; Chiu KC, and Samoa R provided administrative, technical, and material support; Chiu KC is the guarantor of this work and takes responsibility for the integrity of the data and accuracy of the data analysis.
Institutional review board statement: The study was reviewed and approved by the NCHS Research Ethics Review Board, Centers for Disease Control and Prevention.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Data is available at the NHANES website https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ken C Chiu, FACE, FCCP, MD, Professor, Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, United States. kenchiumd@gmail.com
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: June 16, 2021
Revised: June 23, 2021
Accepted: October 27, 2021
Article in press: October 27, 2021
Published online: November 15, 2021
Processing time: 200 Days and 16 Hours
Abstract
BACKGROUND

Although much information is available regarding hepatitis C virus infection and diabetes, less is known about the relationship between hepatitis A virus (HAV) infection and diabetes.

AIM

To examine the roles of HAV in diabetes risk.

METHODS

This cross-sectional study population included data from the National Health and Nutrition Examination Survey collected between 2005-2012. Adult subjects (≥ 20 years old) with available body mass index measurements, defined diabetes status, history of HAV vaccination, and HAV serology were included. HAV vaccination was based on self-reported history. Successful HAV immunization was defined as the presence of both vaccination and anti-HAV antibody. HAV infection was defined by the absence of vaccination but presence of anti-hepatitis A antibody. The odds ratio (OR) for diabetes with 95% confidence intervals (95%CI) was calculated for each HAV status and then adjusted for covariates. Sensitivity tests, based on different definitions of diabetes, were performed to verify the results.

RESULTS

Among 19942 subjects, 4229 subjects (21.21%) received HAV vaccination and HAV antibody was present in 9224 subjects (46.25%). Although HAV infection was associated with an increased risk of diabetes (OR: 1.13; 95%CI: 1.08-1.18), HAV vaccination was not associated with diabetes (OR: 1.06; 95%CI: 0.95-1.18), and successful HAV immunization had no impact on the risk of diabetes (OR: 1.11; 95%CI: 0.97-1.27). Thus, HAV infection was an unlikely cause of diabetes. Alternatively, in non-vaccinated subjects, diabetes increased the risk of HAV infection by 40% (OR: 1.40, 95%CI: 1.27-1.54).

CONCLUSION

An association between HAV infection and diabetes is observed which is best explained by an increased risk of HAV infection in diabetic patients. Diabetic subjects are more susceptible to HAV. Thus, HAV vaccination is highly recommended in diabetic patients.

Keywords: Vaccination; Immunization; Viral hepatitis; Liver; Glucose metabolism; Diabetes mellitus

Core Tip: The relationship of hepatitis A virus (HAV) infection and diabetes was examined. Although an association between HAV infection and diabetes was observed, neither HAV vaccination or successful HAV immunization had no impact on the risk of diabetes. Thus, HAV infection did not increase the risk of diabetes. In contrast, in non-vaccinated subjects, diabetes increased the risk of HAV infection by 40%. Thus, diabetic patients should receive HAV vaccination.