Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1928
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
The liver plays an important role in glucose hemostasis. Hepatitis C infection increases the risk of diabetes. Thus, other liver infection could also play a role in the pathogenesis of diabetes.
This study is to dissect the relationship between hepatitis A and diabetes.
The objective of this study is to investigate the interaction between hepatitis A and diabetes through hypothesis testing in a representative adult cohort of the United States.
The information on hepatitis A vaccination history, hepatitis A antibody status, and diabetes status were obtained from the participants in the National Health and Nutrition Examination Survey 2005-2012. Hepatitis A infection was defined as the presence of hepatitis A antibody without hepatitis A vaccination. Hepatitis A vaccination was defined as the presence of hepatitis A vaccination, regardless hepatitis A antibody status. Successful hepatitis A immunization was defined as the presence of both hepatitis A vaccination and hepatitis A antibody. A stepwise hypothesis testing approach was used to dissect the interaction between hepatitis A and diabetes and the sensitivity tests based on the different definitions of diabetes were used to confirm the results.
Diabetes risk was increased in the participants with hepatitis A infection, suggesting a causal relationship between hepatitis A infection and diabetes. However, hepatitis A vaccination and also successful hepatitis A immunization did not reduce the risk of diabetes, excluding hepatitis A infection as a cause of diabetes. In non-hepatitis A vaccinated participants, diabetes increased the risk of hepatitis A infection by 40%.
Hepatitis A is not a cause of diabetes. Instead, diabetes increases the risk of hepatitis A infection.
Since hepatitis A mortality increases in patients with diabetes, hepatitis A vaccination is highly recommended in patients with diabetes.