Commentary: coincidental metabolic syndrome increases the risk of liver fibrosis progression in patients with chronic hepatitis B.

Abstract

In thiswell-designed and important study, the authors describepotential progression of liver fibrosis in a large cohort oftreatment-na€ive chronic hepatitis B South East Asianinfected individuals. A cohort of the group developedliver fibrosis progression, defined as liver stiffness mea-surement (LSM) ≥30% from baseline.Within this cohort, a number of factors were associ-ated with LSM progression, independent of viral loadand hepatitis activity: coincidental metabolic syndrome(presence of metabolic syndrome at follow-up, not seenat baseline), central obesity and low HDL cholesterol.The significance levels for central obesity and low HDLcholesterol were modest (P values 0.05 and 0.04 respec-tively); however, coincidental metabolic syndrome wasmore impressive (P value 0.015, odds ratio 1.1–3.5).It should be noted, however, that the mean follow-upperiod was 44 7 months, a relatively short period inthe development and progression of fibrosis. The authorsalso describe and concede the difficulties in performingtransient elastography (TE) in an obese population. Per-haps what is of most interest is within the cohort ofindividuals who develop LSM progression, with coinci-dental metabolic syndrome development. The authors donot describe the potential for the development ofnon-alcoholic steatohepatitis (NASH) within this group,nor indeed the impact this may have on LSM.By definition, development of coincidental metabolicsyndrome is a risk factor for the development of NASH.Although TE is validated in both viral hepatitis andNASH,