Avaliação do Estado Nutricional e Composição Corporal em pacientes com Hepatite B Crônica e sua associação com fatores metabólicos

Abstract

Background: In addition to factors related to hepatitis B virus (HBV), other risk factors have been associated with negative outcomes of chronic hepatitis B and reduced antiviral response. These include metabolic alterations, including hepatic steatosis, Metabolic Associated Fatty Liver Disease (MAFLD), increased body mass index (overweight/obesity) and type 2 diabetes mellitus. These factors may play a relevant role in patients with quiescent viral activity. In this context, treatment-naïve patients with viral load (HBV-DNA) are particularly included.low as well as those who are on prolonged treatment with antiviral therapy composed of nucleos(t)ide analogues and evolve with effective virological suppression. Methods: This project was approved by the UFMG Research Ethics Committee. Inclusion criteria were: confirmed diagnosis of chronic hepatitis B - presence of reactive HBsAg for at least six months and detectable HBV-DNA; 18 years of age or older; accept to participate in the research after signing the Free and Informed Consent Term (ICF). Exclusion criteria were: coinfection by the virus: HCV or HIV; diagnosis of neoplasia, including hepatocellular carcinoma (HCC) patients with causes of liver disease other than HCV infection and advanced disease such as chronic kidney disease, heart failure, chronic lung disease, and neoplasia, including HCC; decompensated cirrhosis; pregnant or lactating women. Sarcopenia was assessed by the appendicular lean soft tissue index (ALSTI); ALST (sum of lean soft tissue of upper and lower limbs adjusted to body mass index (BMI)), through dual emission densitometry with X-ray source plus assessment of muscle function. The latter was evaluated by hand grip strength [from English, handgrip strength (HGS) adjusted to BMI (HGSIMC)] using the Jamar® dynamometer. Sarcopenia severity was assessed by gait speed using the timed get-up-and-go test. Sarcopenia was defined as the lowest quintile for sex-specific ALSTI and HGSIMC cut-off values (<0.759 for males and <0.503 for women) and (<1.2 for men and <0.65 for women), respectively, modified from the Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project consensus. Sarcopenic obesity (OS) was defined by the presence of sarcopenia and body fat percentage >27.0% and >38.0% for men and women, respectively. MAFLD was defined according to the international consensus formed by experts. The shape body index (ABSI) was used to assess the presence of abdominal obesity. The International Physical Activity Questionnaire was used to determine the level of physical activity. Associations were analyzed in logistic regression models. Results: A total of 105 patients with chronic hepatitis B participated (mean age, 48.5 + 12.0 years; 58.1%, men; 76.2%, without cirrhosis; 23.8%, with compensated cirrhosis). Sarcopenic obesity, reduced ALSTI, and decreased HGSIMC were found in 4.8%, 21.9%, and 10.5% patients, respectively. In all patients with sarcopenic obesity, MALFD and sedentary lifestyle were identified. In the multivariate analysis, reduced ALSTI (reduced mass) was positively associated with MAFLD, sedentary lifestyle and high ABSI. Decreased HGSIMC (reduced strength) was associated with MAFLD and elevated ABSI. After adjusting for confounders, in male patients, liver cirrhosis was independently associated with age >50 years, elevated ABSI, and hepatic steatosis. Conclusion: Appendicular lean soft tissue abnormalities were associated with MAFLD and abdominal obesity in patients with chronic HBV infection. These findings may contribute to the development of effective strategies to screen for tissue abnormalities/lean mass and metabolic dysfunctions in patients with chronic hepatitis B, regardless of the stage of liver disease.