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

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.