Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;7(1):e000543.
doi: 10.1136/bmjgast-2020-000543.

Less liver fibrosis marker increment in overweight chronic hepatitis B patients observed by age-adjusted Fibrosis-4 Index

Ta-Wei Liu  1   2   3   4   5   6 , Chung-Feng Huang  1   4   5   6 , Ming-Lun Yeh  1   4   5   6 , Pei-Chien Tsai  1   4   5 , Tyng-Yuan Jang  3   5 , Jee-Fu Huang  1   2   4   5   6 , Chia-Yen Dai  1   4   5   6 , Wan-Long Chuang  1   4   5   6 , Ming-Lung Yu  7   4   5   6
Affiliations

Less liver fibrosis marker increment in overweight chronic hepatitis B patients observed by age-adjusted Fibrosis-4 Index

Ta-Wei Liu et al. BMJ Open Gastroenterol. 2020 Dec.

Abstract

Background and aims: Chronic hepatitis B patients in Taiwan with no or limited liver injury are not reimbursed for antiviral treatment by the Taiwan National Health Insurance (NHI). Innovative fibrosis marker, age-adjusted Fibrosis-4 Index (FIB4-AA), was implemented to evaluate the tendency of liver fibrosis in these patients.

Methods: The FIB-4 indices of 256 antiviral treatment-naïve chronic hepatitis B patients at Kaohsiung Medical University Hospital from 2003 to 2019 were reviewed. The difference in initial FIB-4 and last FIB4-AA was treated as a categorical variable, representing the tendency of liver fibrosis in each individual aside from ageing. Logistic regression was implemented to evaluate the three parameters most dependent on increment of FIB4-AA: e seroconversion, body mass index (BMI) and initial FIB-4 index.

Results: The yearly FIB-4 growth rate of an individual without chronic hepatitis was lower than that of the study group (0.0237 vs 0.0273 for males, 0.02 vs 0.0288 for females). Patients undergoing or completing e seroconversion were less prone to increment of FIB4-AA (p=0.036, OR 0.524). Logistic regression revealed that BMI ≥25 kg/m2 significantly less increment of FIB4-AA (p=0.001, OR 0.383, 95% CI 0.212 to 0.690), while patients with initial FIB-4 <1.29 were prone to increasing liver FIB4-AA (p=0.000, OR 3.687, 95% CI 1.999 to 6.797).

Conclusion: Chronic hepatitis B patients not meeting the reimbursement criteria of the Taiwan NHI are prone to increment of liver fibrosis marker. Overweight is associated with less increment of fibrosis marker, while initial FIB-4 <1.29 is associated with increasing fibrosis marker.

Keywords: hepatic fibrosis; hepatitis B; obesity.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cut-off BMI and significant dependence on less liver fibrosis. The significance (p value) of cut-off BMI values ranging from 22 to 30 kg/m2 was examined to determine the dependence between BMI and progression of liver fibrosis. Significant dependence (p<0.05) on negative FIB4-AA growth, or ‘less progression of liver fibrosis’, was found for BMIs ranging from 23 to 28 kg/m2, and the minimal p value appeared at BMI ≥25 kg/m2 (p=0.0054). BMI, body mass index; FIB4, Fibrosis-4 Index.
Figure 2
Figure 2
The OR of cut-off BMI values ranging from 22 to 30 kg/m2 was examined. A larger BMI tends to have an OR <1, which implies protection from liver fibrosis. ORs <0.5 were observed for cut-off BMI values ranging from ≥25 to 30 kg/m2, and the minimal OR (0.431) appeared at BMI ≥28 kg/m2. BMI, body mass index.
Figure 3
Figure 3
For initial FIB-4 <1.0 (n=116), 1.0–1.29 (n=44), 1.29–1.6 (n=32), 1.6–2.65 (n=44) and >2.65 (n=20), the percentages of positive FIB4-AA growth were 69.83%, 47.73%, 62.5%, 36.36% and 10.00%, respectively. The trend was significant (p=6.00E-07) in that patients with a lower initial FIB-4 index tended to have progressive fibrosis. FIB-4, Fibrosis-4 Index.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Li J, Gordon SC, Rupp LB, et al. . The validity of serum markers for fibrosis staging in chronic hepatitis B and C. J Viral Hepat 2014;21:930–7. 10.1111/jvh.12224 - DOI - PubMed
    1. Parikh P, Ryan JD, Tsochatzis EA. Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection. Ann Transl Med 2017;5:40 10.21037/atm.2017.01.28 - DOI - PMC - PubMed
    1. Kim BK, Kim DY, Park JY, et al. . Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients. Liver Int 2010;30:546–53. 10.1111/j.1478-3231.2009.02192.x - DOI - PubMed
    1. Tapper EB, Lok AS-F. Use of liver imaging and biopsy in clinical practice. N Engl J Med 2017;377:756–68. 10.1056/NEJMra1610570 - DOI - PubMed
    1. Conjeevaram HS, Lok AS-F. Management of chronic hepatitis B. J Hepatol 2003;38:90–103. 10.1016/S0168-8278(02)00431-2 - DOI - PubMed

LinkOut - more resources

  NODES
chat 1
INTERN 8
twitter 2