Gut 58:111-117 doi:10.1136/gut.2008.157735
  • Hepatology

Metabolic syndrome increases the risk of liver cirrhosis in chronic hepatitis B

  1. G L-H Wong1,2,
  2. V W-S Wong1,2,
  3. P C-L Choi3,
  4. A W-H Chan3,
  5. A M-L Chim1,2,
  6. K K-L Yiu1,2,
  7. H-Y Chan1,2,
  8. F K-L Chan1,2,
  9. J J-Y Sung1,2,
  10. H L-Y Chan1,2
  1. 1
    Institute of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China
  2. 2
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Hong Kong SAR, China
  3. 3
    Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China
  1. Dr H L Y Chan, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China; hlychan{at}
  • Revised 19 August 2008
  • Accepted 27 August 2008
  • Published Online First 2 October 2008


Background: Metabolic syndrome is associated with non-alcoholic steatohepatitis and cryptogenic cirrhosis. Whether metabolic syndrome affects the severity of chronic hepatitis B (CHB) is unclear.

Aim: We aimed to study the relationship between metabolic syndrome and the risk of liver cirrhosis in patients with CHB.

Methods: We prospectively recruited patients with CHB from primary care and hospital clinics for liver stiffness measurement (LSM) with transient elastography to diagnose early cirrhosis. Probable cirrhosis was defined as LSM ⩾13.4 kPa. We analysed a subgroup of patients with paired LSM and liver biopsies to validate the accuracy of LSM.

Results: 1466 patients had reliable LSM and 134 (9%) patients had adequate liver biopsy. 188 (13%) patients had metabolic syndrome. Histological liver cirrhosis was present in 32/134 (24%) patients. Histological liver cirrhosis was more common among patients who had metabolic syndrome (38%) versus those who did not (11%, p<0.001). The specificity of probable cirrhosis on LSM for histological cirrhosis was 94%. Probable cirrhosis was present in 187 (13%) patients. Metabolic syndrome was more prevalent in patients with probable cirrhosis (24%) than those without cirrhosis (11%, p<0.001). After adjustment for anthropometric, biochemical and virological factors, metabolic syndrome remained an independent factor associated with probable cirrhosis (odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.6). The odds ratios of probable cirrhosis were 1.4 (95% CI, 0.9 to 2.3), 2.6 (95% CI, 1.7 to 4.3), 4.1 (95% CI, 2.4 to 7.1), 4.0 (95% CI, 1.9 to 8.4) and 5.5 (95% CI, 1.8 to 16.7) in patients with one, two, three, four and five components of metabolic syndrome, respectively.

Conclusion: Metabolic syndrome is an independent risk factor of liver cirrhosis in CHB.


  • Competing interests: FK-LC received an independent research grant and a consulting fee from Pfizer and was paid lecture fees by TAP Pharmaceuticals. JJ-YS received consulting fees from the National Health Research Institutes of Taipei, The Hong Kong Police Force, Lippincott Williams & Wilkins, and the Hong Kong College of Physicians and was paid lecture fees by AstraZeneca Hong Kong Ltd, GSK Pharmaceuticals International, and the American Society for Gastrointestinal Endoscopy. HL-YC is a member of the advisory boards of Novartis Pharmaceutics, Bristol-Myers Squibb and Schering-Plough. The other authors do not have any competing interests.

  • Ethics approval: The study protocol was approved by the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee, on 21 June 2006.