Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2012; 18(42): 6120-6126
Published online Nov 14, 2012. doi: 10.3748/wjg.v18.i42.6120
Association of chronic viral hepatitis B with insulin resistance
Jeong Gyu Lee, Sangyeoup Lee, Yun Jin Kim, Byung Mann Cho, Joo Sung Park, Hyung Hoi Kim, JaeHun Cheong, Dong Wook Jeong, Yu Hyun Lee, Young Hye Cho, Mi Jin Bae, Eun Jung Choi
Jeong Gyu Lee, Yun Jin Kim, Yu Hyun Lee, Mi Jin Bae, Department of Family Medicine, Pusan National University School of Medicine, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea
Jeong Gyu Lee, Yun Jin Kim, Yu Hyun Lee, Mi Jin Bae, Department of Family Medicine, Medical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea
Sangyeoup Lee, Medical Education Unit, Pusan National University School of Medicine, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea
Sangyeoup Lee, Family Medicine Clinic, Yangsan Pusan National University Hospital, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea
Byung Mann Cho, Department of Preventive Medicine and Occupational Medicine, Pusan National University School of Medicine, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea
Joo Sung Park, Department of Family Medicine, Dong-A University Medical Center, Busan 602-715, South Korea
Hyung Hoi Kim, Department of Laboratory Medicine, Biomedical Informatics Unit, Pusan National University School of Medicine, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea
JaeHun Cheong, Department of Molecular Biology, College of Natural Sciences, Pusan National University, Busan 602-739, South Korea
Dong Wook Jeong, Young Hye Cho, Eun Jung Choi, Family Medicine Clinic, Yangsan Pusan National University Hospital, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea
Author contributions: Lee JG developed study design and concept, collected of data and drafting of the manuscript; Lee S developed study concept, interpretation of data; Kim YJ studied supervision; Cho BM statistical analysis; Park JS interpretation of data; Kim HH acquisition of data; Cheong J technical support; Jeong DW acquisition of data; Lee YH acquisition of data; Cho YH acquisition of data; Bae MJ acquisition of data; and Choi EJ acquisition of data.
Correspondence to: Sangyeoup Lee, MD, Family Medicine Clinic, Yangsan Pusan National University Hospital, Beomeo-ri Mulgeum-eup, Yangsan 626-770, South Korea. saylee@pnu.edu
Telephone: +82-10-91345959 Fax: +82-51-5108125
Received: July 12, 2012
Revised: September 19, 2012
Accepted: September 22, 2012
Published online: November 14, 2012
Abstract

AIM: To investigate the relationship between chronic viral hepatitis B (CVHB) and insulin resistance (IR) in Korean adults.

METHODS: A total of 7880 adults (3851 men, 4029 women) who underwent a comprehensive medical examination were enrolled in this study. Subjects diagnosed with either diabetes mellitus, or any other disorder that could influence their insulin sensitivity, were rejected. Anthropometry, metabolic risk factors, hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, fasting plasma glucose and insulin were measured for all subjects. Homeostasis model assessment (HOMA), quantitative insulin check index (QUICKI), and Mffm index were used for determining insulin sensitivity. Each participant was categorized into a negative, recovery, or CVHB group. To compare variables between groups, a t-test and/or one-way analysis of variance were used. Partial correlation coefficients were computed to present the association between insulin resistance and other variables. Multiple logistic regression analysis was used to assess the independent association between CVHB and IR.

RESULTS: The mean age of men and women were 48.9 and 48.6 years, respectively. Subjects in the CVHB group had significantly higher waist circumference [(86.0 ± 7.7 cm vs 87.3 ± 7.8 cm, P = 0.004 in men), (78.3 ± 8.6 cm vs 80.5 ± 8.5 cm, P < 0.001 in women)], cystatin C [(0.96 ± 0.15 mg/dL vs 1.02 ± 0.22 mg/dL, P < 0.001 in men), (0.84 ± 0.15 mg/dL vs 0.90 ± 0.16 mg/dL, P < 0.001 in women)], fasting insulin [(5.47 ± 3.38 μU/mL vs 6.12 ± 4.62 μU/mL, P < 0.001 in men), (4.57 ± 2.82 μU/mL vs 5.06 ± 3.10 μU/mL, P < 0.001 in women)] and HOMA index [(1.24 ± 0.86 vs 1.43 ± 1.24, P < 0.001 in men), (1.02 ± 0.76 vs 1.13 ± 0.87, P = 0.033 in women)] compared to control group. The HOMA index revealed a positive correlation with body mass index (BMI) (r = 0.378, P < 0.001), waist circumference (r =0.356, P < 0.001), percent body fat (r = 0.296, P < 0.001), systolic blood pressure (r = 0.202, P < 0.001), total cholesterol (r = 0.134, P < 0.001), triglycerides (r = 0.292, P < 0.001), cystatin C (r = 0.069, P < 0.001) and uric acid (r = 0.142, P < 0.001). The QUICKI index revealed a negative correlation with BMI (r = -0.254, P < 0.001), waist circumference (r = 0-0.243, P < 0.001), percent body fat (r = -0.217, P < 0.001), systolic blood pressure (r = -0.132, P < 0.001), total cholesterol (r = -0.106, P < 0.001), triglycerides (r = -0.205, P < 0.001), cystatin C (r = -0.044, P < 0.001) and uric acid (r = -0.096, P < 0.001). For subjects identified with IR, the odds ratio of an accompanying diagnosis of chronic hepatitis B was 1.534 (95% CI: 1.158-2.031, HOMA index criteria) or 1.566 (95% CI: 1.124-2.182, QUICKI criteria) after adjustment for age, gender, BMI, and amount of alcohol consumption.

CONCLUSION: Our study demonstrates that CVHB is associated with IR. CVHB may need to be monitored for occurrence of IR and diabetes mellitus.

Keywords: Hepatitis B; Insulin resistance; Diabetes mellitus, type 2; Metabolic syndrome