Prevalence of nonalcoholic fatty liver disease in patients with hepatitis B: A meta-analysis

Table 1 Study characteristics

Ref.	Study location	Number of NAFLD	Sample size (HBV+ /HBV-)	Age (year)	Gender (F/M)	Subtype of study	Diagnosis of fatty liver	Follow	Adjusted OR/RR (95%CI)
Wang et al[20], 2008	Taiwan	257	50/457	44.6 ± 1.4/46.8 ± 0.4	264/243	case- control	ultrasonography	NA	0.97 (0.48, 1.95)
Yun et al[21], 2009	Korea	44	68/18	21.0 (20-26)	0/86	case- control	liver biopsy	2005-2006	1.19 (1.17,2.83)
Wong et al[22], 2012	Hong Kong	273	91/922	49 ± 10/48 ± 11	580/433	cross-sectional	MRS	2008-2010	0.42 (0.20, 0.88)
Cheng et al[23], 2013	Taiwan	14671	3642/29797	51.9 ± 13.1	15182/18257	cross- sectional	ultrasonography	2002-2009	0.66 (0.59, 0.72)
Peng et al[24], 2013	China	527	253/922	20-74	438/1131	case- control	ultrasonography	2007-2008	3.96 (2.10, 7.48)
Yilmaz et al[25], 2015	Turkey	28	88/0	31 ± 1.1	27/61	cross-sectional	Liver biopsy	NA	0.21 (0.11,0.41)
Chan et al[26], 2017	Hong Kong	107	270/0	43.6 ± 11.3	67/203	cohort	Liver biopsy	2006-2009	0.43 (0.30,0.60)
Joo et al[27], 2017	Korea	20200	3926/79413	38.5 (7.2)/ 37.5 (7.6)	40856/42483	Cohort	ultrasonography	2002-2014	0.78 (0.72,0.84)
Zhong et al[28], 2018	China	631	291/2697	45-66	1849/1139	case-control	ultrasonography	2015-2016	0.64 (0.42,0.95)
Azarkar et al[12], 2019	Iran	336	373/447	41.1 ± 12.9/39.8 ± 13.9	403/420	case- control	ultrasonography	2013-2014	0.62 (0.455,0.845)
Lee et al[29], 2019	Korea	70	321/0	41 (33-49)	125/196	cohort	Liver biopsy	2007-2015	1.56 (0.90,2.71)
Peleg et al[30], 2019	Israel	241	524/0	42.32 (18.5-83.5)	209/315	cohort	ultrasonography	2007-2017	0.08 (0.02,0.28)
Sharif et al[31], 2019	Pakistan	166	230/0	36.8 ± 10.84	27/203	cross-sectional	Transient elastography	2018-2019	5.4 (3.62,8.03)
Wang et al[13], 2019	China	308	152/1714	46.42 ± 10.291	1866/0	cohort	ultrasonography	2011-2014	0.656 (0.379,1.134)
Zhu et al[32], 2019	China	283	2393/0	50.7 ± 13.2	1767/626	cohort	ultrasonography	2012-2015	0.89 (0.69,1.15)
Huang et al[33], 2020	China	4917	2110/12342	43.84 ± 13.03	6710/7742	cohort	ultrasonography	2016-2018	0.717 (0.608,0.846)
Su et al[34], 2020	Taiwan	104	30/74	49.97 ± 14.76	47/57	cross-sectional	Liver biopsy	2009-2018	3.55 (1.46,8.58)
Zhuang et al[35], 2020	China	88	46/42	37.37 ± 10.11/39.64 ± 12.31	13/75	cross-sectional	MRS	2013-2016	0.322 (0.095,0.550)
Lv et al[10], 2021	China	6315	5680/10771	42.6 ± 11.2/46.9 ± 10.6	6519/9932	cohort	ultrasonography	2013-2017	NA
Zhou et al[36], 2022	China	32	78/105	45.41 ± 11.59	54/129	cross-sectional	ultrasonography	2019-2020	1.95 (0.90,4.22)

NAFLD: Nonalcoholic fatty liver disease; HBV: Hepatitis B virus; F: Female; M: Male; NA: Not applicable; MRS: Magnetic resonance spectroscopy.

Table 2 Scores using modified Newcastle-Ottawa scale for included studies

Ref.	Selection				Comparability	Exposure			Total score
	Fully defined cases	Define the study design	Selection of controls	Described the general characteristics	Controlling the important factors or confounding factors	List inclusion and exclusion criteria for all the participants	Provided Enrollment duration for all the participants	Indicate study period and follow-up duration
Wang et al[20], 2008	*	*		*	2	1	1		7
Yun et al[21], 2009	1		1	1	2	1		1	7
Wong et al[22], 2012	1	1		1	2	1	1	1	8
Cheng et al[23], 2013	1	1		1	2	1		1	7
Peng et al[24], 2013	1	1	1	1		1		1	6
Yilmaz et al[25], 2015	1		1	1	2	1		1	7
Chan et al[26], 2017	1	1	1	1	1	1	1	1	8
Joo et al[27], 2017	1	1	1	1	2	1	1	1	9
Zhong et al[28], 2018	1	1	1	1	2	1		1	8
Azarkar et al[12], 2019	1	1	1	1	2		1	1	8
Lee et al[29], 2019	1	1	1	1	1	1		1	7
Peleg et al[30], 2019	1	1		1	1	1	1	1	7
Sharif et al[31], 2019	1	1		1	2	1		1	7
Wang et al[13], 2019	1	1	1	1	2	1	1	1	9
Zhu et al[32], 2019	1	1	1		2	1	1	1	8
Huang et al[33], 2020	1		1	1	2			1	6
Su et al[34], 2020	1	1		1	1	1	1	1	7
Zhuang et al[35], 2020	1	1	1	1	1	1		1	7
Lv et al[10], 2021	1		1	1	2	1		1	7
Zhou et al[36], 2022	1	1	1	1	1	1		1	7

Table 3 Results of meta-regression analysis of the risk association between hepatitis B infection and nonalcoholic fatty liver disease

Heterogeneous factors	Coef.	SE	95%CI		P value
			Lower	Upper
Age	0.477	0.391	-0.347	1.302	0.061
Year	-0.020	0.055	-0.136	0.096	0.723
Study quality	-0.527	0.734	-2.075	1.021	0.718
Study design	-0.226	0.265	-0.784	0.332	0.959
Diagnosis of fatty liver	-0.095	0.223	-0.565	0.375	0.827
BMI	0.848	0.389	0.233	1.673	0.010
Diabetes	0.790	0.417	-0.112	1.691	0.015
Study location	0.992	0.082	0.832	1.182	0.208
Follow	-0.068	0.057	-0.191	0.054	0.603

BMI: Body mass index.

Table 4 Factors associated with hepatic steatosis in patients with hepatitis B infection

Variable	Number of studies	Random effects model		Heterogeneity			Publication bias
		OR or SMD (95%CI)	P value	Q value	P value	I2	Egger’s P value	Begg’s P value
BMI (kg/m2)	7	OR: 1.24 (1.21, 1.27)	< 0.01	27.79	< 0.01	78.40	0.69	0.88
	5	SMD: 2.40 (1.20, 3.61)	< 0.01	34.11	< 0.01	88.30	0.94	0.73
ALT	5	OR: 1.01 (1.00, 1.03)	0.05	140.35	< 0.01	97.10	0.38	0.81
	5	SMD: 6.76 (0.92, 12.60)	0.02	24.28	< 0.01	83.50	0.01	0.46
Creatinine	2	SMD: 4.73 (4.15, 5.31)	< 0.01	0.17	0.68	0.00	NA	0.32
UA	3	SMD: 64.24 (60.75, 67.74)	< 0.01	0.59	0.74	0.00	0.16	0.60
FBG	6	OR: 1.58 (1.13, 1.77)	< 0.01	114.14	< 0.01	95.60	0.49	0.85
	5	SMD: 1.55 (1.43, 1.68)	< 0.01	9.86	0.04	59.40	0.92	0.81
Cholesterol	7	SMD: 0.37 (0.12, 0.62)	< 0.01	37.01	< 0.01	83.80	0.01	0.76
LDL-C	6	SMD: 0.28 (0.03, 0.52)	0.03	66.65	< 0.01	92.50	0.06	0.71
Triglyceride	6	OR: 1.71 (1.14, 2.55)	0.01	59.19	< 0.01	91.60	0.04	0.45
HOMA-IR	3	OR: 1.46 (1.17, 1.83)	< 0.01	6.68	0.03	70.90	0.40	0.60

BMI: Body mass index; ALT: Alanine aminotransaminase; UA: Uric acid; FBG: Fasting blood glucose; LDL-C: Low-density lipoprotein cholesterol; HOMA-IR: Homeostasis model assessment of insulin resistance; SMD: Standardized mean differences.