84; CI, 1.30-6.76; for BMI ≥27.5 kg/m2), presence of diabetes or IFG (OR, 4.45; CI, 1.10-30.00), and the PNPLA3 148M allele (OR, 1.62; CI, 1.00-7.00; per each 148M allele). The only independent predictors of advanced steatosis were higher
BMI (OR, 3.60; CI, 1.39-9.22;for BMI ≥27.5 kg/m2) and the 148M PNPLA3 allele (OR, 6.03; CI, 1.23-5.00; per each 148M buy Opaganib allele). Similarly, higher BMI (OR, 2.38; CI, 1.22-4.82; for BMI ≥27.5 kg/m2) and the 148M PNPLA3 allele (OR, 1.70; CI, 1.07-2.74; per each 148M allele) were independently associated with NAS >2. Because the phenotypic expression of the I148M PNPLA3 polymorphism has been reported to be dependent on the presence of acquired cofactors triggering steatosis, including Fluorouracil mouse obesity and alcohol, we next evaluated whether the association of the 148M allele and severe steatosis was dependent on the presence of severe overweight (BMI, ≥27.5 kg/m2) and a positive history of alcohol intake. Either one of these acquired risk factors was present in 82 (35%) of patients, and this condition was associated with a higher prevalence of steatosis (60 of 82 [73%] versus 86 of 153 [56%]; P = 0.01) and severe steatosis (13 of 82 [16%] versus 11 of 153 [7%]; P = 0.04). The PNPLA3 148M allele was associated with a progressive increase in the prevalence of severe steatosis in patients with, but not in those without, acquired
Pyruvate dehydrogenase cofactors, that is, severe overweight and regular consumption of any amount of alcohol (Fig. 1; P = 0.001 in patients with cofactors). Independent
predictors of advanced fibrosis at multivariate logistic regression analysis are presented in Table 4. Advanced fibrosis was associated with older age (OR, 4.17; CI, 2.21-8.13; for age >50 years), HBeAg positivity (OR, 2.53; CI, 1.16-5.72), but not with gender and viral load. Interestingly, advanced fibrosis was also independently associated with a positive history of any degree of alcohol consumption (OR, 2.09; CI, 1.02-4.32) and higher BMI (OR, 1.11; CI, 1.02-1.22; per g/m2), that is, two known risk factors for steatosis, whereas the association of advanced fibrosis with severe steatosis was not independent of these variables, although a nonsignificant trend was observed (OR, 2.56; CI, 0.98-7.60). Similarly, there was a trend for an independent association of NAS with advanced fibrosis, when this variable was introduced in the model in substitution of severe steatosis (OR, 1.15; CI, 0.98-1.35; P = 0.08). This is the first study demonstrating an association between the 148M PNPLA3 allele and an increased risk of both steatosis of any degree and severe steatosis in CHB patients. The association with severe steatosis was particularly evident in patients with comorbidities, such as increased body mass and abnormal alcohol intake.