Beyond fibrosis: The imperative for dual steatosis and fibrosis assessment in chronic hepatitis B and metabolic dysfunction-associated steatotic liver disease co-pathology

doi:10.4254/wjh.v18.i5.118817

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. May 27, 2026; 18(5): 118817
Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.118817

Beyond fibrosis: The imperative for dual steatosis and fibrosis assessment in chronic hepatitis B and metabolic dysfunction-associated steatotic liver disease co-pathology

Francesco Giangregorio, Elisa Civaschi, Samanta Mazzocchi, Davide Romano, Paolo Clini, Esther Centenara, Umberto Casale, Davide Catucci

Francesco Giangregorio, Elisa Civaschi, Samanta Mazzocchi, Davide Romano, Paolo Clini, Esther Centenara, Umberto Casale, Davide Catucci, Department of Internal Medicine, Val Tidone Hospital, Castel San Giovanni 29015, Emilia-Romagna, Italy

Author contributions: Giangregorio F and Civaschi E contributed to conceptualization; Giangregorio F contributed to methodology, software, writing-original draft preparation, writing-review and editing, project administration, funding acquisition; Giangregorio F, Mazzocchi S, and Romano D contributed to validation; Clini P contributed to formal analysis, visualization; Centenara E contributed to investigation, supervision; Casale U contributed to resources; Catucci D contributed to data curation; All authors have read and agreed to the published version of the manuscript.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

Corresponding author: Francesco Giangregorio, Associate Professor, Chief Physician, Director, Department of Internal Medicine, Val Tidone Hospital, Viale II Giugno 1, Castel San Giovanni 29015, Emilia-Romagna, Italy. f.giangregorio67@gmail.com

Received: January 12, 2026
Revised: January 20, 2026
Accepted: February 11, 2026
Published online: May 27, 2026
Processing time: 134 Days and 15.8 Hours

Core Tip

Core Tip: Non-invasive assessment of liver injury in chronic hepatitis B is evolving beyond static fibrosis markers toward biologically driven models. The L59-based nomogram proposed by Dai et al captures active fibrogenesis through transforming growth factor-βactivation, integrating molecular, inflammatory, and hematologic parameters. This approach is particularly relevant in patients with concurrent metabolic dysfunction-associated steatotic liver disease, where steatosis may be deceptively mild despite advanced fibrosis. A dual, non-invasive evaluation of fibrosis and steatosis is therefore essential to avoid underestimation of disease severity and to optimize risk stratification in dual-etiology liver disease.