Epidemiology of concurrent non-alcoholic fatty liver disease in chronic hepatitis B patients and its impact on long-term outcomes

Hepatitis B virus infection and non-alcoholic fatty liver disease are two primary factors that can lead to chronic liver disease, which can result in serious complications such as liver cirrhosis and hepatocellular carcinoma. It is observed that the number of patients with non alcoholic fatty liver disease and chronic hepatitis B virus infection is increasing day by day, and the long-term prognosis of both diseases is unfavorable. Nowadays, the coexistence of these two diseases is becoming increasingly common. Therefore, the potential relationship between chronic hepatitis B and non-alcoholic fatty liver disease has become an important area of research. Between 2017 and 2023, patients who applied to Trakya University due to chronic hepatitis B and underwent liver biopsy were included in the study. A total of 470 patients were retrospectively examined. Due to the presence of other concomitant liver diseases or incomplete clinical and laboratory data, 141 patients were excluded from the study. The remaining 329 patients included in the study were initially divided into 3 groups. The first group consisted of 192 patients with only chronic hepatitis B, the second group included 98 patients with chronic hepatitis B accompanied by non-alcoholic fatty liver disease (diagnosed radiologically or histologically), and the third group comprised 39 patients with chronic hepatitis B accompanied by non-alcoholic steatohepatitis. It was observed that non-alcoholic fatty liver disease in patients with chronic hepatitis B has a prevalence similar to that of the general population but higher than expected. Patients with chronic hepatitis B accompanied by non-alcoholic fatty liver disease were older than those with only chronic hepatitis B. Male gender and metabolic factors were found to increase the risk of developing non-alcoholic fatty liver disease in patients with chronic hepatitis B, while female gender was significantly higher in patients with non-alcoholic steatohepatitis. In our study, it was observed that non-alcoholic steatohepatitis could exacerbate liver fibrosis in patients with chronic hepatitis B. Additionally, a significant relationship was found between moderate to advanced disease activity, the presence of advanced fibrosis and cirrhosis development in patients with chronic hepatitis B, and the presence of non-alcoholic steatohepatitis and metabolic factors. Considering these data, addressing concomitant non alcoholic fatty liver disease through lifestyle management and disease screening is of great importance in achieving better prognoses in patients with chronic hepatitis B