Bhatti TK, Lim JK. Diagnosis and management of metabolic dysfunction-associated steatohepatitis in patients with chronic hepatitis B infection. World J Gastroenterol 2026; 32(9): 115544 [DOI: 10.3748/wjg.v32.i9.115544]
Corresponding Author of This Article
Joseph K Lim, MD, Professor, Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520, United States. joseph.lim@yale.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 7, 2026 (publication date) through Mar 2, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Bhatti TK, Lim JK. Diagnosis and management of metabolic dysfunction-associated steatohepatitis in patients with chronic hepatitis B infection. World J Gastroenterol 2026; 32(9): 115544 [DOI: 10.3748/wjg.v32.i9.115544]
World J Gastroenterol. Mar 7, 2026; 32(9): 115544 Published online Mar 7, 2026. doi: 10.3748/wjg.v32.i9.115544
Diagnosis and management of metabolic dysfunction-associated steatohepatitis in patients with chronic hepatitis B infection
Talal K Bhatti, Joseph K Lim
Talal K Bhatti, Center for Liver Disease and Transplantation, Northwell Health, Manhasset, NY 11030, United States
Joseph K Lim, Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, New Haven, CT 06520, United States
Author contributions: Bhatti TK contributed to the literature review, interpretation of data, drafting of the manuscript, and final approval of the article; Lim JK contributed to the conception and design of the review, literature review, interpretation of data, critical revision of the intellectual content of the manuscript, and final approval of the article.
Conflict-of-interest statement: Bhatti TK reports no relationships; Lim JK reports research contracts (to Yale University) from Akero, Becton Dickinson, Gilead, Inventiva, Novo Nordisk, Pfizer, Viking.
Corresponding author: Joseph K Lim, MD, Professor, Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520, United States. joseph.lim@yale.edu
Received: October 20, 2025 Revised: December 2, 2025 Accepted: January 14, 2026 Published online: March 7, 2026 Processing time: 131 Days and 2.7 Hours
Abstract
Chronic hepatitis B (CHB) infection is a global public health burden, affecting over 250 million persons globally, and is associated with substantial morbidity and mortality due to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Metabolic syndrome and metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly common co-morbidity among patients with CHB, affecting an estimated 25%-40% of individuals. The physiologic and clinical impact of co-existing CHB and metabolic syndrome and/or MASLD [met-hepatitis B virus (HBV)] is poorly understood, although recent data suggest important associations with poorer antiviral response and clinical outcomes. This review summarizes current and emerging evidence addressing this relationship, and outline recommendations for the diagnosis, risk stratification, staging, and management of Met-HBV.
Core Tip: In context of a growing global burden of obesity and diabetes mellitus, metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic syndrome are increasingly observed in patients with chronic hepatitis B (CHB) virus infection. The relationship between hepatic steatosis and/or metabolic syndrome with CHB is complex and remains incompletely defined, although multiple cohort studies reveal an association with liver inflammation, liver fibrosis, hepatitis B virus (HBV)-related liver events such as cirrhosis, liver failure, and liver cancer, as well as biochemical and virologic response to antiviral therapy. Therefore, a dual diagnosis of MASLD and CHB, also termed met-HBV, may have important implications for management. Probable met-HBV can initially be identified on the basis of liver imaging, but a confirmed diagnosis can be established on vibration-controlled transient elastography-based controlled attenuation parameter score or liver biopsy. Patients diagnosed with met-HBV should undergo active management of MASLD and other manifestations of the metabolic syndrome. Future cohort studies and controlled trials are needed to inform evidence-based approaches to management.
