Letter to the Editor: Hepatic steatosis and glycemic burden in chronic hepatitis B
Journal
Hepatology (Baltimore, Md.)
Journal Volume
78
Journal Issue
1
Pages
E11
Date Issued
2023-07-01
Author(s)
Abstract
To the editor, We read with great interest the study by Mak et al.1 The authors prospectively enrolled 671 chronic hepatitis B (CHB) patients with type 2 diabetes mellitus and found a positive association between high glycemic burden and HCC development as well as fibrosis progression. Notably, a nonlinear effect of glycemic burden was disclosed in the restricted cubic spline analyses. It would be interesting and important to explore whether the paradoxically lower risk of HCC in the outliers with higher glycemic burden was confounded by concomitant hepatic steatosis. In the authors’ previous study using the same CHB cohort,2 more severe hepatic steatosis defined by high controlled attenuation parameter (CAP) was significantly associated with a lower risk of HCC, implying fatty liver may be a protective factor in CHB. In the current study, patients with type 2 diabetes mellitus had a higher CAP, which was a neutral factor (HR=0.997) for HCC in the univariable analysis. Since type 2 diabetes mellitus was a risk factor for HCC, it is plausible that the protective effect of high CAP was offset by the accompanying glycemic burden. Taken together, the readers may have an interest in learning whether the paradoxically lower risk in the outliers with the higher glycemic burden (who tended to have a high CAP) would remain after adjustment for steatosis and whether a high CAP was a protective factor in the multivariable analysis, as was observed in their earlier study.2 In summary, Mak and colleagues are congratulated for the excellent research highlighting the key role of glycemic control in preventing adverse liver outcomes. Investigating the interaction and the exact impacts of modifiable metabolic factors and hepatic steatosis on CHB may provide crucial insights into the optimal management strategy in our daily clinical practice.
SDGs
Type
letter