Metabolic Factors in Chronic Hepatitis B and Liver Disease

Chronic hepatitis B (CHB) is increasingly recognised as a complex disorder in which viral replication intersects with host metabolic pathways to influence disease progression. Metabolic factors such as insulin resistance, dyslipidaemia and hepatic steatosis drive inflammatory signalling, oxidative stress and fibrogenesis, thereby modifying the risk of cirrhosis, hepatocellular carcinoma and treatment response. Alterations in fatty acid handling, lipid droplet accumulation and aberrant glycosylation of lipoproteins further exacerbate hepatocyte injury. As obesity and type 2 diabetes rise globally, understanding these metabolic–viral interactions has become essential for optimising surveillance, combining antiviral therapy with metabolic interventions and identifying non-invasive biomarkers of liver injury.

Research from Nature Portfolio

Serum lipidomic profiling in patients with CHB and fatty liver has revealed distinct patterns of neutral lipids, ceramides and plasmalogens across healthy controls, NAFLD cases and CHB subjects with or without steatosis. A key finding was that elevated monounsaturated triacylglycerol strongly predicted steatohepatitis and correlated with histological activity more accurately than alanine transaminase or cytokeratin-18. This non-invasive lipid marker offers promise for identifying progressive liver injury in both CHB and NAFLD populations.

Metabolic Factors in Chronic Hepatitis B and Liver Disease publication trend

The graph below shows the total number of articles in metabolic factors in chronic hepatitis b and liver disease across all publications each year (not limited to Nature Index journals).

Technical terms

Hepatic steatosis: Accumulation of triglyceride-rich lipid droplets within hepatocytes, often assessed by imaging or biopsy.

Metabolic dysfunction-associated fatty liver disease (MAFLD): Diagnosis of fatty liver with concurrent metabolic risk factors such as overweight, type 2 diabetes or dyslipidaemia.

Steatohepatitis: Inflammatory liver injury characterised by hepatocyte ballooning and mixed inflammatory infiltrate on a background of steatosis.

Triacylglycerol (TAG): A glycerol esterified with three fatty acids, stored in lipid droplets and circulating in lipoproteins.

Lipotoxicity: Cellular damage resulting from accumulation of toxic lipid species that trigger oxidative stress and inflammatory signalling.

References

1. Chronic hepatitis B associated with hepatic steatosis, insulin resistance, necroinflammation and fibrosis. African Health Sciences (2015).
2. The Hepatitis B Virus X Protein Inhibits Secretion of Apolipoprotein B by Enhancing the Expression of N-Acetylglucosaminyltransferase III*. Journal of Biological Chemistry (2004).
3. Serum Monounsaturated Triacylglycerol Predicts Steatohepatitis in Patients with Non-alcoholic Fatty Liver Disease and Chronic Hepatitis B. Scientific Reports (2017).
4. Metabolic dysfunction-associated fatty liver disease increases risk of adverse outcomes in patients with chronic hepatitis B. JHEP Reports (2021).
5. NAFLD and HBV interplay - related mechanisms underlying liver disease progression. Frontiers in Immunology (2022).
6. Inverse Association between Hepatitis B Virus Infection and Fatty Liver Disease: A Large-Scale Study in Populations Seeking for Check-Up. PLOS ONE (2013).