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The Association Between Chronic Hepatitis B and Metabolic Syndrome: †The Third Korean National Health and Nutrition Examination Survey
Mo1072 Bioelectric Impedance Measurements as Predictors of HCV-Related Hepatic Fibrosis and Inflammation Donna L. White, Shahriar Tavakoli-Tabasi, Jill Kuzniarek, Rhia Pascua, David J. Ramsey, Jodi Francis, Hashem El-Serag
#Adjusted for age, current alcohol use, and ethnicity
High Total Serum Testosterone is Associated With Increased Risk of Advanced Hepatic Fibrosis and Inflammatory Activity in Male Veterans With Chronic Hepatitis C Donna L. White, Shahriar Tavakoli-Tabasi, Jill Kuzniarek, Rhia Pascua, David J. Ramsey, Jodi Francis, Hashem El-Serag Background: Hepatocellular carcinoma (HCC) risk is greatly increased in males. Several experimental and epidemiologic research studies found increasing testosterone levels were associated with increased HCC risk in males with chronic hepatitis B infection. However, much less is known about whether testosterone similarly increases risk of advanced hepatic fibrosis or inflammatory activity within a background of chronic hepatitis C virus (HCV) infection. Methods: We prospectively recruited consecutive HCV+ veterans seen in the dedicated hepatitis C clinic at a single large urban VA medical center. Recruitment was limited to African-American and Caucasian males ages 20-70, chronically mono-infected with HCV and not currently receiving treatment. Venipuncture was performed to: 1) confirm viral status, 2) complete the validated Fibrosure test as a proxy measure for hepatic biopsy assessed pathology, and 3) to measure total serum testosterone level. We performed two sets of logistic regression analyses to evaluate the association between total testosterone and advanced fibrosis (F3/F4 and F4) and advanced inflammatory activity (A2/A3 and A3) respectively. All multivariate analyses included adjustment for age, ethnicity and viral load. Results: We recruited N=218 HCV+ male veterans between May 2009 and October 2010. Mean age was 56.5 years, 54% were African-American, and mean total serum testosterone was 5.6 ng/ml (SD 2.30). In univariate analysis, HCV+ veterans with advanced fibrosis (n= 70) had higher mean serum testosterone (p=0.06) and were younger (57.6 vs. 55.9 yrs; p= 0.02) than those with mild fibrosis (n=148). In contrast, HCV+ veterans with advanced inflammatory activity (n=55) were less likely to be African-American than those with mild inflammatory activity (p=0.08). Multivariate analysis demonstrated a 1 ng/ml increase in total serum testosterone was associated with a significant 21% increase in advanced fibrosis risk after adjusting for age, ethnicity, and viral load (OR=1.21, 95% CI 1.05-1.38, p=0.006). A 1 ng/ml increase in total serum testosterone was also associated with a 14% increased advanced inflammation risk that closely approached significance (OR=1.14, 95% CI 0.9991.38, p=0.052). Conclusion: Increased serum testosterone is associated with significantly increased risk of advanced hepatic fibrosis and inflammation in male veterans with chronic HCV. Larger prospective studies are needed to confirm our findings in male veterans and to assess if a similar association exists in HCV+ females. Mo1074 The Association Between Chronic Hepatitis B and Metabolic Syndrome: †The Third Korean National Health and Nutrition Examination Survey Sangheun Lee, Hee Man Kim, Dae Jung Kim, Jae Hee Cho, Ki Joon Han Backgrounds and Aim Chronic hepatitis C patients have higher prevalence of insulin resistance and type 2 diabetes mellitus than healthy controls or chronic hepatitis B patients. The relationship between chronic hepatitis B and metabolic syndrome remains unclear. We investigated an association between chronic hepatitis B and metabolic syndrome. Methods The Third Korean National Health and Nutrition Examination Survey (KNHANES) was conducted by the Korea Ministry of Health and Welfare in 2005. The data obtained from the Third KNHANES were analyzed. Chronic hepatitis B was defined as positivity of HBsAg. Metabolic syndrome was defined by the modified NCEP ATP III for Koreans. Results Of the 5108 subjects, 209 (4.1%) had chronic hepatitis B, and 1364 (26.7%) had metabolic syndrome. In univariate analysis, the subjects with chronic hepatitis B were not different in prevalence of metabolic syndrome (21.1% vs. 26.9%), alcohol intake (69.9% vs. 75.1%), smoking (41.4% vs. 37.7%), exercise (47.4% vs. 47.6%), diabetes mellitus (7.7% vs. 8.6%), hypertension (25.4% vs. 26.7%), and obesity (36.4% vs. 32.4%) than those without chronic hepatitis B. However, in multivariate analysis, odds ratio of chronic hepatitis B was 0.6 (95% CI: 0.4-0.9, P=0.017) for metabolic syndrome after adjustment with age, gender, drinking, smoking, exercise, diabetes mellitus, hypertension, and obesity. Conclusions Chronic hepatitis B is strongly associated with the decreased risk of metabolic syndrome. † The Third Korea National Health and Nutrition Examination Survey (KNHANES), 2005, Korea Centers for Disease Control and Prevention
#Based on single direct, 8 segment, and multichannel bioimpedance scale measurement. Table 2. Multivariate evaluation of the association between BIA- and anthropometric-based measurements and risk of advanced fibrosis and advanced inflammatory activity in 198 male veterans with chronic HCV #.
S-969
AASLD Abstracts
AASLD Abstracts
Mo1073
Background: Increased relative adiposity, measured as BMI or waist circumference, is a recognized risk factor for HCV-related liver disease. Bioelectric impedance analysis (BIA)based measurements of adiposity offer advantages including less inter-observer variability compared with widely used anthropometric calculations. There have been no studies of BIA in association with HCV-related liver disease. Methods: HCV+ male veterans with confirmed HCV viremia and without ascites or decompensated disease were recruited at a single VA medical center. We obtained direct 8-segment multi-frequency BIA measurements of body composition with Biospace Inbody scale (98% correlation with DXA, 99% reproducibility). BIA measurements (<5 minutes in duration) were taken after entering study measured height, gender and age. Fibrosure test was used to assess grade of fibrosis and inflammation. We also obtained other conventional anthropometric measurements (waist, hips). ANOVA was employed to compare mean BIA and anthropometric measurements with advanced compared to mild fibrosis (F3-F4, F4 vs. F0-F3), and with advanced compared to mild inflammatory activity (A2, A2-A3, A3 vs. A0, A1, A1-A2). Logistic regression was employed to evaluate these factors and risk of advanced liver disease after adjusting for ethnicity, age and current alcohol use. Results: We recruited 198 HCV+ male veterans (mean age 56 yrs; 52% AfricanAmerican; 43% non-Hispanic White). BIA-measured body fatness (%BF) and BMI were significantly associated with advanced hepatic fibrosis in univariate (Table 1) and multivariate (Table 2) analyses. Similar associations were observed with advanced inflammation (data not shown). However, waist and hip circumference obtained from conventional tape measurements were not significantly associated with fibrosis in univariate or multivariate analyses, though both were marginally significant for inflammation. There were no significant differences in total body water or lean body mass among groups with advanced and mild hepatic disease (Tables 1, 2). This indicates that the observed associations with %BF and BMI are primarily related to differences in relative fatness and not in water retention or muscular atrophy. The correlation between BMI and %BF was significant and moderately strong (Kendal tau-b=64%), with similar correlation observed for both BMI and %BF with waist and hip circumference respectively. Conclusion: Bioimpedance analysis (BIA) measured %BF and BIA calculated BMI both predict the presence of advanced hepatic fibrosis and inflammation in HCV+ male veterans. BIA measurements were easy, quick, and highly reproducible. Given the degree of correlation among these measures, additional research is needed to clarify their joint and individual contributions in risk of advanced liver disease. Table 1. Univariate assessment of bioelectric impedance analysis (BIA)- and anthropometricbased measurements in 198 male veterans with chronic HCV.
#Adjusted for age, current alcohol use, and ethnicity
High Total Serum Testosterone is Associated With Increased Risk of Advanced Hepatic Fibrosis and Inflammatory Activity in Male Veterans With Chronic Hepatitis C Donna L. White, Shahriar Tavakoli-Tabasi, Jill Kuzniarek, Rhia Pascua, David J. Ramsey, Jodi Francis, Hashem El-Serag Background: Hepatocellular carcinoma (HCC) risk is greatly increased in males. Several experimental and epidemiologic research studies found increasing testosterone levels were associated with increased HCC risk in males with chronic hepatitis B infection. However, much less is known about whether testosterone similarly increases risk of advanced hepatic fibrosis or inflammatory activity within a background of chronic hepatitis C virus (HCV) infection. Methods: We prospectively recruited consecutive HCV+ veterans seen in the dedicated hepatitis C clinic at a single large urban VA medical center. Recruitment was limited to African-American and Caucasian males ages 20-70, chronically mono-infected with HCV and not currently receiving treatment. Venipuncture was performed to: 1) confirm viral status, 2) complete the validated Fibrosure test as a proxy measure for hepatic biopsy assessed pathology, and 3) to measure total serum testosterone level. We performed two sets of logistic regression analyses to evaluate the association between total testosterone and advanced fibrosis (F3/F4 and F4) and advanced inflammatory activity (A2/A3 and A3) respectively. All multivariate analyses included adjustment for age, ethnicity and viral load. Results: We recruited N=218 HCV+ male veterans between May 2009 and October 2010. Mean age was 56.5 years, 54% were African-American, and mean total serum testosterone was 5.6 ng/ml (SD 2.30). In univariate analysis, HCV+ veterans with advanced fibrosis (n= 70) had higher mean serum testosterone (p=0.06) and were younger (57.6 vs. 55.9 yrs; p= 0.02) than those with mild fibrosis (n=148). In contrast, HCV+ veterans with advanced inflammatory activity (n=55) were less likely to be African-American than those with mild inflammatory activity (p=0.08). Multivariate analysis demonstrated a 1 ng/ml increase in total serum testosterone was associated with a significant 21% increase in advanced fibrosis risk after adjusting for age, ethnicity, and viral load (OR=1.21, 95% CI 1.05-1.38, p=0.006). A 1 ng/ml increase in total serum testosterone was also associated with a 14% increased advanced inflammation risk that closely approached significance (OR=1.14, 95% CI 0.9991.38, p=0.052). Conclusion: Increased serum testosterone is associated with significantly increased risk of advanced hepatic fibrosis and inflammation in male veterans with chronic HCV. Larger prospective studies are needed to confirm our findings in male veterans and to assess if a similar association exists in HCV+ females. Mo1074 The Association Between Chronic Hepatitis B and Metabolic Syndrome: †The Third Korean National Health and Nutrition Examination Survey Sangheun Lee, Hee Man Kim, Dae Jung Kim, Jae Hee Cho, Ki Joon Han Backgrounds and Aim Chronic hepatitis C patients have higher prevalence of insulin resistance and type 2 diabetes mellitus than healthy controls or chronic hepatitis B patients. The relationship between chronic hepatitis B and metabolic syndrome remains unclear. We investigated an association between chronic hepatitis B and metabolic syndrome. Methods The Third Korean National Health and Nutrition Examination Survey (KNHANES) was conducted by the Korea Ministry of Health and Welfare in 2005. The data obtained from the Third KNHANES were analyzed. Chronic hepatitis B was defined as positivity of HBsAg. Metabolic syndrome was defined by the modified NCEP ATP III for Koreans. Results Of the 5108 subjects, 209 (4.1%) had chronic hepatitis B, and 1364 (26.7%) had metabolic syndrome. In univariate analysis, the subjects with chronic hepatitis B were not different in prevalence of metabolic syndrome (21.1% vs. 26.9%), alcohol intake (69.9% vs. 75.1%), smoking (41.4% vs. 37.7%), exercise (47.4% vs. 47.6%), diabetes mellitus (7.7% vs. 8.6%), hypertension (25.4% vs. 26.7%), and obesity (36.4% vs. 32.4%) than those without chronic hepatitis B. However, in multivariate analysis, odds ratio of chronic hepatitis B was 0.6 (95% CI: 0.4-0.9, P=0.017) for metabolic syndrome after adjustment with age, gender, drinking, smoking, exercise, diabetes mellitus, hypertension, and obesity. Conclusions Chronic hepatitis B is strongly associated with the decreased risk of metabolic syndrome. † The Third Korea National Health and Nutrition Examination Survey (KNHANES), 2005, Korea Centers for Disease Control and Prevention
#Based on single direct, 8 segment, and multichannel bioimpedance scale measurement. Table 2. Multivariate evaluation of the association between BIA- and anthropometric-based measurements and risk of advanced fibrosis and advanced inflammatory activity in 198 male veterans with chronic HCV #.
S-969
AASLD Abstracts
AASLD Abstracts
Mo1073
Background: Increased relative adiposity, measured as BMI or waist circumference, is a recognized risk factor for HCV-related liver disease. Bioelectric impedance analysis (BIA)based measurements of adiposity offer advantages including less inter-observer variability compared with widely used anthropometric calculations. There have been no studies of BIA in association with HCV-related liver disease. Methods: HCV+ male veterans with confirmed HCV viremia and without ascites or decompensated disease were recruited at a single VA medical center. We obtained direct 8-segment multi-frequency BIA measurements of body composition with Biospace Inbody scale (98% correlation with DXA, 99% reproducibility). BIA measurements (<5 minutes in duration) were taken after entering study measured height, gender and age. Fibrosure test was used to assess grade of fibrosis and inflammation. We also obtained other conventional anthropometric measurements (waist, hips). ANOVA was employed to compare mean BIA and anthropometric measurements with advanced compared to mild fibrosis (F3-F4, F4 vs. F0-F3), and with advanced compared to mild inflammatory activity (A2, A2-A3, A3 vs. A0, A1, A1-A2). Logistic regression was employed to evaluate these factors and risk of advanced liver disease after adjusting for ethnicity, age and current alcohol use. Results: We recruited 198 HCV+ male veterans (mean age 56 yrs; 52% AfricanAmerican; 43% non-Hispanic White). BIA-measured body fatness (%BF) and BMI were significantly associated with advanced hepatic fibrosis in univariate (Table 1) and multivariate (Table 2) analyses. Similar associations were observed with advanced inflammation (data not shown). However, waist and hip circumference obtained from conventional tape measurements were not significantly associated with fibrosis in univariate or multivariate analyses, though both were marginally significant for inflammation. There were no significant differences in total body water or lean body mass among groups with advanced and mild hepatic disease (Tables 1, 2). This indicates that the observed associations with %BF and BMI are primarily related to differences in relative fatness and not in water retention or muscular atrophy. The correlation between BMI and %BF was significant and moderately strong (Kendal tau-b=64%), with similar correlation observed for both BMI and %BF with waist and hip circumference respectively. Conclusion: Bioimpedance analysis (BIA) measured %BF and BIA calculated BMI both predict the presence of advanced hepatic fibrosis and inflammation in HCV+ male veterans. BIA measurements were easy, quick, and highly reproducible. Given the degree of correlation among these measures, additional research is needed to clarify their joint and individual contributions in risk of advanced liver disease. Table 1. Univariate assessment of bioelectric impedance analysis (BIA)- and anthropometricbased measurements in 198 male veterans with chronic HCV.