Research conducted by a local hospital has found that hepatitis B patients with a simple fatty liver have a lower mortality risk than those without, suggesting that excessive fat in the liver could play a protective role against hepatitis B by potentially inhibiting viral replication.
“Hepatitis B affects more than 300 million people worldwide and is a leading cause of liver cirrhosis and liver cancer,” National Taiwan University Hospital (NTUH) Department of Internal Medicine clinical assistant professor Su Tung-Hung (蘇東弘) said at a news conference at NTUH on Wednesday.
Su added that an estimated 2 million people in Taiwan are carriers of chronic hepatitis B, a viral liver disease which can be transmitted through blood, bodily fluids or from mother to child.
Photo: CNA
While acute hepatitis B has no specific treatment and chronic hepatitis B can be managed with oral antiviral medications, there is still no highly effective treatment for hepatitis B in general, NTUH Bei-Hu Branch’s Department of Gastroenterology and Hepatology attending physician Huang Shang-chin (黃上秦) said.
Su said many chronic hepatitis B carriers in Taiwan also have metabolic dysfunction, including diabetes, hypertension, obesity and fatty liver disease, due to dietary habits and lifestyles becoming increasingly Westernized in recent years.
As the long-term impact of metabolic dysfunction and fatty liver disease on people with chronic hepatitis B has not yet been fully understood, the NTUH hepatitis research team conducted a study using long-term monitoring data collected by the hospital from 2006 to 2021 and analyzed more than 10,000 hepatitis B patients, he said.
The study, published in Journal of Hepatology in December last year, found that chronic hepatitis B patients with metabolic dysfunction had a significantly higher all-cause mortality rate, with the risk increasing as the number of metabolic disorders increased, Su said.
People with three or more metabolic dysfunctions face more than double the all-cause mortality risk compared with those without any metabolic dysfunctions, he added.
Among metabolic dysfunctions, diabetes poses the greatest threat to hepatitis B patients. Those who have HbA1c (glycated hemoglobin) levels that exceed 8 percent have a liver disease-related mortality risk four times higher than those with levels below 6 percent, Su said.
An unexpected finding in the study was that hepatitis B patients who only had simple fatty liver disease had about 50 percent lower all-cause mortality risk compared with hepatitis B patients who had neither fatty liver disease nor cardiometabolic-related issues, he said.
“Those [excessive] fats may have an inhibitory effect on the replication of the hepatitis B virus,” Su added.
Asked whether deliberately inducing simple fatty liver in patients could be a potential strategy to combat hepatitis B, Huang said that it is not easy to do, as most cases of fatty liver are accompanied by a metabolic syndrome.
“It is impossible for us to clinically control for a condition where a patient develops simple fatty liver without metabolic dysfunctions,” he added.
However, with further experiments and research on why simple fatty liver can suppress or even clear the hepatitis B virus, researchers might be able to identify the underlying mechanisms, Huang said.
“If we can pinpoint those mechanisms, there is potential to develop targeted medicines based on them,” he added.
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