Associations of Chronic Hepatitis B and Nonalcoholic Fatty Liver Diseases with New-Onset Metabolic Syndrome in Military Personnel before Midlife: A Cohort Study

Kun-Zhe Tsai; Pang-Yen Liu; Yen-Chen Lin; Chen-Ming Huang; Hui-Shang Wang; Gen-Min Lin

doi:10.2174/0118715303323078241022050619

Associations of Chronic Hepatitis B and Nonalcoholic Fatty Liver Diseases with New-Onset Metabolic Syndrome in Military Personnel before Midlife: A Cohort Study

Endocr Metab Immune Disord Drug Targets. 2025 Jan 9. doi: 10.2174/0118715303323078241022050619. Online ahead of print.

Authors

Kun-Zhe Tsai^{1

2

3}, Pang-Yen Liu⁴, Yen-Chen Lin⁵, Chen-Ming Huang⁶, Hui-Shang Wang⁷, Gen-Min Lin^{1

4}

Affiliations

¹ Department of Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.
² Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei, Taiwan.
³ Department of Periodontology, School of Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan.
⁴ Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁵ Department of Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁶ Department of Cardiovascular Surgery, Mennonite Christian Hospital, Hualien City, Taiwan.
⁷ Division of Cardiology, Department of Internal Medicine, Hualien Tzu Chi General Hospital, Hualien City, Taiwan.

PMID: 39806964
DOI: 10.2174/0118715303323078241022050619

Abstract

Background: Hepatic inflammation, e.g., Nonalcoholic Fatty Liver Diseases (NAFLD) and the severe form of steatohepatitis (NASH), has been associated with a higher risk of MetS in the general population.

Aims: This study aimed to investigate the associations of chronic hepatitis B (CHB) and fatty liver diseases with the incidence of metabolic syndrome (MetS) in young adults, which have not been verified before.

Objective: The associations between NAFLD, NASH, and CHB and the incidence of new-onset MetS remain inconclusive in young adults.

Methods: This cohort study included 2,614 military personnel aged 18-39 years who were free of baseline MetS in 2014 and were followed for the incidence of MetS in each annual health examination until the end of 2020. CHB was defined by the presence of the hepatitis B surface antigen with an established diagnosis history. NAFLD and NASH were defined by the ultrasound finding with an elevated alanine transaminase (27-53.9 and ≥54 U/L in men and 15-29.9 and ≥30 U/L in women, respectively). MetS was defined based on the International Diabetes Federation criteria. Multivariable Cox regression analysis was used to determine the associations between hepatitis and incident MetS.

Results: During a mean follow-up of 6.0 years, 582 new-onset MetS cases occurred (22.3%). NAFLD and NASH were associated with a greater risk of new-onset MetS (hazard ratios (HRs) and 95% confidence intervals: 1.47 (1.21-1.79) and 1.66 (1.16-2.39), respectively), while no association for CHB was found (HR: 1.31 (0.88-1.96)).

Conclusion: This study found that NAFLD and NASH, while not CHB, were independent risk factors of new-onset MetS with adjustments for potential covariates, e.g., physical activity and fitness in young adults.

Keywords: Chronic hepatitis B; metabolic syndrome; military health.; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; young adults.