Tyng‐Yuan Jang, Yu-ting Zeng, Po‐Cheng Liang, Chih-Wen Wang, Yi‐Hung Lin, Chih‐Da Wu, Pei-Chien Tsai, Ming-Yen Hsieh, Meng‐Hsuan Hsieh, Jeng-Fu Yang, Ming-Lun Yeh, Chung‐Feng Huang, Wan‐Long Chuang, Jee-Fu Huang, Chia-Yen Dai, Pau‐Chung Chen, Ming-Lung Yu
Background To investigate the association between air pollution and hepatic steatosis in patients with chronic hepatitis B. Methods This cross-sectional study enrolled 1068 patients with chronic hepatitis B treated with nucleotide/nucleoside analogs from 2020 to 2023 in Kaohsiung and analyzed the incidence and risk factors for hepatic steatosis. Daily air pollutant concentrations were estimated for the year prior to enrolment. Results Patients with hepatic steatosis were reported in 340 (31.8%). Patients with hepatic steatosis had higher concentrations of nitrogen oxides (NO x ) compared to those without steatosis (27.8 ppb vs. 25.5 ppb; P = 0.001). Logistic regression analysis revealed that non-liver-cirrhosis was the strongest factor associated with hepatic steatosis (odds ratio (OR)/confidence interval (CI): 4.63/2.85-7.52; P < 0.001), followed by hypertriglyceridemia (OR/CI: 2.09/1.29-3.39; P < 0.001),HBeAg seropositivity (OR/CI: 1.54/1.05-2.26; P = 0.04), BMI (OR/CI: 1.10/1.06-1.14; P < 0.001) and concentrations of NO x (OR/CI: 1.018/1.004-1.033; P = 0.01). Among patients without cirrhosis, logistic regression analysis revealed that the strongest factors associated with hepatic steatosis were hypertriglyceridemia (OR/CI: 1.98/1.17-3.35; P = 0.01), followed by HBeAg seropositivity (OR/CI: 1.51/1.05-2.17; P = 0.03), BMI (OR/CI: 1.10/1.05-1.14; P < 0.001) and concentrations of NO x (OR/CI: 1.02/1.01-1.04; P = 0.01). Patients in the highest quartile of annual NO x -concentration exposure had a two-fold increased risk of hepatic steatosis compared with those in the lowest quartile (OR/CI: 2.20/1.37-3.50). Among patients with cirrhosis, logistic regression analysis revealed that the strongest factors associated with hepatic steatosis were hypertriglyceridemia (OR/CI: 3.79/1.22-11.79; P = 0.02), followed by age (OR/CI: 0.95/0.92-0.99; P = 0.02). Conclusions Higher concentrations of NO x were associated with hepatic steatosis in patients with non-cirrhotic chronic hepatitis B.