Association Between the Hepatitis B and C Viruses and Metabolic Diseases in Patients Stratified by Age

Wen-Cheng Li; Yi-Yen Lee; I-Chuan Chen; Cheng Sun; Feng-Hsiang Chiu; Chung-Hsun Chuang


Liver International. 2013;33(8):1194-1202. 

In This Article

Patients and Methods


Between 2008 and 2010, medical records of subjects >15 years who underwent routine physical examinations at various branches of the Chang Gung Memorial Hospital were identified from the clinical database. Subjects who did not fast for >12 h, were pregnant, were taking antihypertensive/hypolipidaemic/hypoglycaemic drugs or had an endocrine disorder (e.g. thyroid, pituitary, adrenal diseases) were excluded. This study was approved by the Institutional Review Board of the Chang Gung Memorial Hospital.

Data Collection

Participants were interviewed using questionnaires administered by trained nurses. Information regarding demographics, lifestyle (smoking and drinking habits), history of illness and medication use and physiological status was collected. Definitions of smoking and alcohol consumption status for subjects were as follows: current smokers (if they were actively smoking); previous smokers (if they had quit smoking for the past 6 months); nonsmokers (if they had never smoked); current alcohol consumption (if they were actively drinking regardless of amount); previous alcohol consumption (if they had quit drinking for the past 6 months); and never consume alcohol (if they had never consumed alcohol).

Systolic and diastolic blood pressures (SBP and DBP) were measured with a random zero sphygmomanometer with all subjects in a sitting position after a 5 min rest. Up to three measurements were averaged. Height and weight were measured by an automatic scale with the subject standing straight, feet together and looking straight ahead. Body mass index (BMI) was calculated (kg/m2). Waist circumference (WC) was measured with each subject standing with their feet 25–30 cm apart, midway between the iliac crest and the lower margin of the twelfth rib.

A venous blood sample was obtained from each subject following a 12-hr fast. Samples were stored at 4°C until time of analysis. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL), triglyceride (TG), fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL), hepatitis B serum antigen (HBsAg), anti-HCV antibodies and glutamic pyruvic transaminase (GPT) levels were determined for each participant. Hepatitis B serum antigen (HBsAg) and anti-HCV antibodies levels were determined using commercial kits (Roche Elecsys, Roche Diagnostics GmbH, Mannheim, Germany). For the HBsAg assay, nonreactive was <0.9, equivocal ('weakly positive') was 0.9–10 and reactive was >10. For the anti-HCV assay, nonreactive was <1, equivocal ('weakly positive') was 1–10 and reactive was >10. Subjects infected by both HBV and HCV were excluded.

Participants were considered to have diabetes if they reported the current usage of antidiabetic medications, reported a previous diagnosis of diabetes, or had a fasting plasma glucose >126 mg/dl. A diagnosis of metabolic syndrome was defined as a subject presenting with at least three of the five factors for metabolic syndrome described in the report by Grundy et al.[9]

Statistical Analysis

Data were stratified by both age and gender. Rationale for this stratification were that the prevalence of HCV infection between patients < 45 years and >45 year was different (with older subjects likely having chronic infections) and because menopause (in women) might affect lipid metabolism. Previous studies (e.g. Lao et al.) similarly used an age cut-off.[10]

Categorical variables were presented as count and percentage and continuous variables were presented as mean ± standard deviation, except BMI, TG and GPT were presented by median and interquartile range because of their nonnormal distributions. Comparisons between groups in categorical variables, normally distributed continuous variables and nonnormally distributed continuous variables were performed using the Fisher's exact test, one-way analysis of variance and the Kruskal–Wallis test respectively. The Bonferroni post hoc test was performed for comparisons of pair-wise groups. All statistical hypothesis tests were two-sided, and P values <0.05 were considered significant. Analyses were performed with the spss 15.0 statistics software (SPSS Inc., Chicago, IL, USA).