J Lipid Atheroscler.  2016 Dec;5(2):133-143. 10.12997/jla.2016.5.2.133.

Serum Lipid Level in HBsAg Carriers without a History of Hepatitis based on Nationwide Health and Nutrition Examination Datasets

• Koo BK
• Moon MK

• KMID: 2366138
• DOI: http://doi.org/10.12997/jla.2016.5.2.133

Abstract

OBJECTIVE
We investigated serum lipid levels in asymptomatic HBsAg carriers and the general population using the Korean National Health and Nutrition Examination Survey (KNHANES).
METHODS
We analyzed the data of patients aged ≥30 years from the KNHANES 2007-2014 datasets. Subjects with diabetes mellitus, triglyceride levels >1000 mg/dL, a history of heavy alcohol consumption, or lipid-lowering medication were excluded. HBsAg carriers were divided into "unknown HBsAg carrier" and "known HBsAg carrier" according to previous self-recognition of HBsAg status using a questionnaire.
RESULTS
Compared with control subjects (n=24,880; male 33.9%; mean age 52±14 years), HBsAg carriers (n=1,061; male 40.6%; mean age 50±13 years) showed significantly higher AST and ALT levels, lower platelet counts and higher body mass index (BMI) (all p<0.001). HBsAg carriers revealed lower total cholesterol, LDL cholesterol and triglyceride levels (all p<0.001) compared with control subjects, irrespective of previous awareness of HBsAg positivity. Hypertriglyceridemia and low HDL cholesterolemia were less prevalent even in the "unknown HBsAg carrier" group compared with control subjects [age, sex and BMI-adjusted odds ratio, 0.566 (95% confidence interval, 0.468-0.684) and 0.822 (0.708-0.956), respectively].
CONCLUSION
In conclusion, HBsAg carriers exhibited low total cholesterol, LDL cholesterol, and triglyceride levels compared with control subjects. Hypertriglyceridemia and low HDL cholesterolemia were also less frequently detected in HBsAg carriers even after adjustments for age, sex, and BMI.

Keyword

Cholesterol; Triglyceride; HDL cholesterol; Hepatitis B virus

MeSH Terms

Alcohol Drinking
Body Mass Index
Cholesterol
Cholesterol, HDL
Cholesterol, LDL
Dataset*
Diabetes Mellitus
Hepatitis B Surface Antigens*
Hepatitis B virus
Hepatitis*
Humans
Hypertriglyceridemia
Male
Nutrition Surveys
Odds Ratio
Platelet Count
Triglycerides
Cholesterol
Cholesterol, HDL
Cholesterol, LDL
Hepatitis B Surface Antigens

Figure

• 

  Fig. 1 Serum total cholesterol (A), LDL cholesterol (B), triglyceride (C) and HDL cholesterol level (D) according to HBsAg status in age group. Total cholesterol and LDL cholesterol levels were compared between HBsAg carriers and control subjects using independent t-test; for comparison of triglyceride and HDL cholesterol level, the Mann-Whitney U test was used. Total cholesterol and LDL cholesterol level in each group was presented as mean value with standard deviation (A, B), and triglyceride and HDL cholesterol level was as median value with interquartile range (C, D). *significantly different compared to control group (p<0.05), †significantly different compared to entire HBsAg carriers (p<0.05)

Reference

1. Fabris C, Federico E, Soardo G, Falleti E, Pirisi M. Blood lipids of patients with chronic hepatitis: differences related to viral etiology. Clin Chim Acta. 1997; 261:159–165.

2. Cicognani C, Malavolti M, Morselli-Labate AM, Zamboni L, Sama C, Barbara L. Serum lipid and lipoprotein patterns in patients with liver cirrhosis and chronic active hepatitis. Arch Intern Med. 1997; 157:792–796.

3. Alaei M, Negro F. Hepatitis C virus and glucose and lipid metabolism. Diabetes Metab. 2008; 34:692–700.

4. Kumar M, Choudhury A, Manglik N, Hissar S, Rastogi A, Sakhuja P, et al. Insulin resistance in chronic hepatitis B virus infection. Am J Gastroenterol. 2009; 104:76–82.

5. Park SH, Kim DJ, Lee HY. Insulin resistance is not associated with histologic severity in nondiabetic, noncirrhotic patients with chronic hepatitis B virus infection. Am J Gastroenterol. 2009; 104:1135–1139.

6. Lee JG, Lee S, Kim YJ, Cho BM, Park JS, Kim HH, et al. Association of chronic viral hepatitis B with insulin resistance. World J Gastroenterol. 2012; 18:6120–6126.

7. Wang CC, Hsu CS, Liu CJ, Kao JH, Chen DS. Association of chronic hepatitis B virus infection with insulin resistance and hepatic steatosis. J Gastroenterol Hepatol. 2008; 23:779–782.

8. Jacobson TA, Miller M, Schaefer EJ. Hypertriglyceridemia and cardiovascular risk reduction. Clin Ther. 2007; 29:763–777.

9. World Health Organization, Noncommunicable Disease and Mental Health Cluster, Department of Mental Health and Substance Dependence. International guide for monitoring alcohol consumption and related harm. Geneva: World Health Organization;2000.

10. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285:2486–2497.

11. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007; 75:72–80.

12. World Health Organization Western Pacific Region. International Association for the Study of Obesity. International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia Pty Limited;2000.

13. Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006; 43:1317–1325.

14. Li Y, Chen Y, Zhao Y. The diagnostic value of the FIB-4 index for staging hepatitis B-related fibrosis: a meta-analysis. PLoS One. 2014; 9:e105728.

15. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANES IV-3). Cheongwon: Korea Centers for Disease Control and Prevention;2010.

16. Jan CF, Chen CJ, Chiu YH, Chen LS, Wu HM, Huang CC, et al. A population-based study investigating the association between metabolic syndrome and hepatitis B/C infection (Keelung Community-based Integrated Screening study No. 10). Int J Obes (Lond). 2006; 30:794–799.

17. Ghadir MR, Riahin AA, Havaspour A, Nooranipour M, Habibinejad AA. The relationship between lipid profile and severity of liver damage in cirrhotic patients. Hepat Mon. 2010; 10:285–288.

18. Bonora E, Coscelli C, Orioli S, Cambi R, Buzzelli G, Gentilini P, et al. Hyperinsulinemia of chronic active hepatitis: impaired insulin removal rather than pancreatic hypersecretion. Horm Metab Res. 1984; 16:111–114.

19. Letiexhe MR, Scheen AJ, Gérard PL, Bastens BH, Pirotte J, Belaiche J, et al. Insulin secretion, clearance, and action on glucose metabolism in cirrhotic patients. J Clin Endocrinol Metab. 1993; 77:1263–1268.

20. Li-Ng M, Tropp S, Danoff A, Bini EJ. Association between chronic hepatitis B virus infection and diabetes among Asian Americans and Pacific Islanders. Dig Liver Dis. 2007; 39:549–556.

21. Lao TT, Tse KY, Chan LY, Tam KF, Ho LF. HBsAg carrier status and the association between gestational diabetes with increased serum ferritin concentration in Chinese women. Diabetes Care. 2003; 26:3011–3016.

22. Kim K, Kim KH, Cheong J. Hepatitis B virus X protein impairs hepatic insulin signaling through degradation of IRS1 and induction of SOCS3. PLoS One. 2010; 5:e8649.