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Less liver fibrosis marker increment in overweight chronic hepatitis B patients observed by age-adjusted Fibrosis-4 Index
  1. Ta-Wei Liu1,2,3,4,5,6,
  2. Chung-Feng Huang1,4,5,6,
  3. Ming-Lun Yeh1,4,5,6,
  4. Pei-Chien Tsai1,4,5,
  5. Tyng-Yuan Jang3,5,
  6. Jee-Fu Huang1,2,4,5,6,
  7. Chia-Yen Dai1,4,5,6,
  8. Wan-Long Chuang1,4,5,6,
  9. Ming-Lung Yu1,4,5,6
  1. 1College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  2. 2Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
  3. 3Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
  4. 4Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
  5. 5Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  6. 6Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  1. Correspondence to Professor Ming-Lung Yu; fish6069{at}


Background and aims Chronic hepatitis B patients in Taiwan with no or limited liver injury are not reimbursed for antiviral treatment by the Taiwan National Health Insurance (NHI). Innovative fibrosis marker, age-adjusted Fibrosis-4 Index (FIB4-AA), was implemented to evaluate the tendency of liver fibrosis in these patients.

Methods The FIB-4 indices of 256 antiviral treatment-naïve chronic hepatitis B patients at Kaohsiung Medical University Hospital from 2003 to 2019 were reviewed. The difference in initial FIB-4 and last FIB4-AA was treated as a categorical variable, representing the tendency of liver fibrosis in each individual aside from ageing. Logistic regression was implemented to evaluate the three parameters most dependent on increment of FIB4-AA: e seroconversion, body mass index (BMI) and initial FIB-4 index.

Results The yearly FIB-4 growth rate of an individual without chronic hepatitis was lower than that of the study group (0.0237 vs 0.0273 for males, 0.02 vs 0.0288 for females). Patients undergoing or completing e seroconversion were less prone to increment of FIB4-AA (p=0.036, OR 0.524). Logistic regression revealed that BMI ≥25 kg/m2 significantly less increment of FIB4-AA (p=0.001, OR 0.383, 95% CI 0.212 to 0.690), while patients with initial FIB-4 <1.29 were prone to increasing liver FIB4-AA (p=0.000, OR 3.687, 95% CI 1.999 to 6.797).

Conclusion Chronic hepatitis B patients not meeting the reimbursement criteria of the Taiwan NHI are prone to increment of liver fibrosis marker. Overweight is associated with less increment of fibrosis marker, while initial FIB-4 <1.29 is associated with increasing fibrosis marker.

  • hepatitis B
  • hepatic fibrosis
  • obesity

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  • Contributors Study concept and design: T-WL and M-LY. Acquisition of data: T-WL, P-CT, C-YD, M-LY and W-LC. Data analysis and interpretation: T-WL, P-CT, M-LY, C-FH, T-YJ, J-FH, C-YD, W-LC and M-LY. Drafting of the manuscript: T-WL. Critical review of the manuscript for important intellectual content: M-LY. Statistical analysis: T-WL, P-CT and C-FH. Administrative, technical and material support: P-CT, T-WL, C-FH and M-LY. Study supervision: W-LC and M-LY. All the authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All enrolled patients gave informed consents as approved by the research ethics committee of Kaohsiung Medical University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data in this study were collected from the patients of Kaohsiung Medical University Hospital by Hepatobiliary Division, Internal Medicine, Kaohsiung Medical University Hospital. Data are available on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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