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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

Observational Study
Copyright ©The Author(s) 2026.
World J Hepatol. Feb 27, 2026; 18(2): 113685
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.113685
Table 1 Diagnostic criteria for metabolic syndrome based on the International Diabetes Federation definition
Component
Diagnostic criterion
Central obesity (mandatory)Waist circumference above the ethnicity-specific threshold1
Plus at least two of the following
Elevated TG≥ 150 mg/dL (1.70 mmol/L) or specific treatment for this lipid abnormality
Reduced HDL-C< 40 mg/dL (< 1.03 mmol/L) in men; < 50 mg/dL (< 1.29 mmol/L) in women, or specific treatment
Elevated blood pressureSystolic ≥ 130 mmHg or diastolic ≥ 85 mmHg, or treatment of previously diagnosed hypertension
Elevated fasting glucose≥ 100 mg/dL (5.60 mmol/L) or previously diagnosed type 2 diabetes
1Ethnic-specific values for waist circumference should be applied (e.g., > 94 cm for men and > 80 cm for women of European origin).
TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol.
Full Size Table
Table 2 Baseline clinical and metabolic characteristics of patients with primary biliary cholangitis, n (%)/mean ± SD (range)
Characteristic
n = 81
Age (years)64.28 ± 10.23 (43-88)
BMI26.54 ± 5.11 (17.81-39.10)
Waist circumference (cm)89.45 ± 13.13 (60.00-121.00)
GenderFemale 78 (96.30); male 3 (3.70)
Coronary artery disease2 (2.50)
Acute coronary syndrome2 (2.50)
History of stroke4 (5)
Peripheral arterial disease1 (1.30)
Complete biochemical response44 (55)
Advanced liver fibrosis F3/F419 (23.50)
Metabolic syndrome33 (40.74)
MASLD39 (48.15)
AST (% of ULN)93.51 ± 39.90 (45.00-215.00)
ALT (% of ULN)85.03 ± 60.44 (25.00-350.00)
GGT (% of ULN)186.39 ± 217.55 (34.92-1506.35)
ALP (% of ULN)102.52 ± 54.40 (38.50-326.50)
Bil-T (μmol/L)12.91 ± 6.08 (5.60-39.70)
Bil-C (μmol/L)2.84 ± 2.01 (1.15-14.60)
Glucose (mmol/L)5.57 ± 1.37 (4.10-12.40)
C-peptide (ng/mL)2.08 ± 1.2 (0.09-7.36)
HOMA-IR5.51 ± 2.64 (2.40-16.32)
TC (mmol/L)5.49 ± 1.21 (3.33-9.12)
HDL-C (mmol/L)1.71 ± 0.40 (0.84-2.79)
LDL-C (mmol/L)3.40 ± 0.90 (1.87-5.75)
TG (mmol/L)1.38 ± 1.24 (0.47-9.20)
Platelets (× 109/L)247.48 ± 79.73 (44-489.00)
Adiponectin (pg/mL)2668.94 ± 2615.75 (367.15-12457.60)
Leptin (ng/mL)1.99 ± 3.16 (0.23-21.97)
CAP (dB/m)236.83 ± 59.09 (108.00-400.00)
Liver stiffness (TE, kPa)8.16 ± 5.35 (2.60-32.60)
L/A ratio2.05 ± 4.59 (0.02-28.56)
BMI: Body mass index; MASLD: Metabolic dysfunction-associated steatotic liver disease; AST: Aspartate aminotransferase; ULN: Upper limit of normal; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Bil-T: Total bilirubin; Bil-C: Conjugated bilirubin; HOMA-IR: Homeostatic model assessment of insulin resistance; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low density lipoprotein-cholesterol; TG: Triglycerides; CAP: Controlled attenuation parameter; TE: Transient elastography; L/A ratio: Leptin-to-adiponectin ratio.
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Table 3 Comparison of clinical and biochemical parameters between primary biliary cholangitis patients with and without metabolic dysfunction-associated steatotic liver disease, mean ± SD/median (interquartile range)
PBC/no MASLD
PBC/MASLD
P value
Number of patients, n (%)42 (51.90)39 (48.90)
Age (years)63.00 ± 11.7065.00 ± 8.200.4521
BMI23.50 ± 3.8030.40 ± 4.00< 0.0011
Waist circumference (cm)81.40 ± 9.1099.10 ± 10.30< 0.0011
AST (% of ULN)86.67 (IQR 46.67)84.93 (IQR 20.00)0.1463
ALT (% of ULN)85.65 (IQR 57.50)73.33 (IQR 40.00)0.7583
GGT (% of ULN)136.51 (IQR 236.51)95.24 (IQR 112.70)0.0413
ALP (% of ULN)95.00 (IQR 51.50)87.50 (IQR 47.00)0.0773
Bil-T (μmol/L)12.80 (IQR 6.30)11.20 (IQR 6.80)0.3923
Bil-C (μmol/L)2.62 (IQR 1.24)2.13 (IQR 2.04)0.4363
Glucose (mmol/L)5.20 (IQR 1.00)5.5 (IQR 1.50)0.3733
C-peptide (ng/mL)1.49 (IQR 0.85)2.44 (IQR 1.47)0.0803
HOMA-IR4.42 (IQR 1.95)5.13 (IQR 2.56)0.1413
TC (mmol/L)5.43 ± 1.235.17 ± 1.220.3271
HDL-C (mmol/L)1.84 ± 0.431.49 ± 0.36< 0.0011
LDL-C (mmol/L)3.33 (IQR 1.39)3.47 (IQR 1.06)0.8392
Ferritin (mg/L)52.90 (IQR 56.80)93.15 (IQR 118.80)0.0042
TG (mmol/L)0.97 (IQR 0.45)1.18 (IQR 0.87)< 0.0013
Platelets (× 109/L)242.5 (IQR 90.25)236 (IQR 109.25)0.3063
Adiponectin (pg/mL)2042.08 (IQR 2678.16)1698.24 (IQR 1998.92)0.0152
Leptin (ng/mL)0.62 (IQR 0.83)1.89 (IQR 2.01)< 0.0012
CAP (dB/m)199.00 (IQR 35.00)278.50 (IQR 55)< 0.0012
Liver stiffness (TE, kPa)6.70 (IQR 4.20)6.55 (IQR 7.70)0.1762
L/A ratio0.27 (IQR 0.37)1.63 (IQR 3.42)< 0.0012
1Independent T-test.
2Independent T-test after log-transformed.
3Mann-Whitney U test.
Significant differences were observed in body mass index, waist circumference, high-density lipoprotein cholesterol, and leptin/adiponectin ratio. Values are presented as raw (untransformed) data, statistical tests were performed on log-transformed values where indicated. PBC: Primary biliary cholangitis; BMI: Body mass index; MASLD: Metabolic dysfunction-associated steatotic liver disease; AST: Aspartate aminotransferase; ULN: Upper limit of normal; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Bil-T: Total bilirubin; Bil-C: Conjugated bilirubin; HOMA-IR: Homeostatic model assessment of insulin resistance; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low density lipoprotein-cholesterol; TG: Triglycerides; CAP: Controlled attenuation parameter; TE: Transient elastography; L/A ratio: Leptin-to-adiponectin ratio; IQR: Interquartile range.
Full Size Table
Table 4 Comparison of metabolic and adipokine profiles in primary biliary cholangitis patients with and without metabolic syndrome, mean ± SD/median (interquartile range)
PBC/no MetS
PBC/MetS
P value
Number of patients, n (%)48 (59.30)33 (40.70)
Age (years)60.60 ± 9.7068.90 ± 8.800.0011
BMI25.40 ± 4.8028.90 ± 5.200.0021
Waist circumference (cm)84.90 ± 11.3097.20 ± 12.20< 0.0011
AST (% of ULN)81.67 (IQR 26.67)78.33 (IQR 70.54)0.4403
ALT (% of ULN)71.67 (IQR 39.58)70.00 (IQR 47.50)0.7403
GGT (% of ULN)112.70 (IQR 203.17)114.29 (IQR 143.65)0.6893
ALP (% of ULN)94.50 (IQR 55.00)89.50 (IQR 38.80)0.2513
Bil-T (μmol/L)11.80 (IQR 5.80)12.10 (IQR 8.00)0.9303
Bil-C (μmol/L)2.27 (IQR 1.43)2.36 (IQR 2.27)0.9183
Glucose (mmol/L)5.10 (IQR 0.10)6.00 (IQR 1.70)< 0.0013
C-peptide (ng/mL)1.45 (IQR 0.81)2.31 (IQR 1.30)< 0.0013
HOMA-IR4.27 (IQR 1.65)5.79 (IQR 3.38)0.0013
TC (mmol/L)5.62 ± 1.064.84 ± 1.310.0061
HDL-C (mmol/L)1.87 ± 0.351.39 ± 0.38< 0.0011
LDL-C (mmol/L)3.49 (IQR 0.97)2.94 (IQR 1.35)0.0292
Ferritin (mg/L)67.40 (IQR 83.00)73.85 (IQR 78.20)0.2702
TG (mmol/L)0.98 (IQR 0.38)1.34 (IQR 0.98)< 0.0013
Platelets (× 109/L)244 (IQR 90.50)226 (IQR 127.5)0.1693
Adiponectin (pg/mL)2086.10 (IQR 2260.08)1208.41 (IQR 3127.60)0.0022
Leptin (ng/mL)0.79 (IQR 1.11)1.51 (IQR 2.43)0.0022
CAP (dB/m)213 (IQR 62)254 (IQR 98)0.0012
Liver stiffness (TE, kPa)6.70 (IQR 3.80)7.2 (IQR 8.03)0.0272
L/A ratio0.41 (IQR 0.59)1.28 (IQR 2.36)0.0092
1Independent T-test.
2Independent T-test after log-transformed.
3Mann-Whitney U test.
Patients with metabolic syndrome showed significantly higher insulin resistance (homeostatic model assessment of insulin resistance), lower adiponectin levels, and increased leptin-to-adiponectin ratio. Values are presented as raw (untransformed) data, statistical tests were performed on log-transformed values where indicated. PBC: Primary biliary cholangitis; MetS: Metabolic syndrome; BMI: Body mass index; AST: Aspartate aminotransferase; ULN: Upper limit of normal; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Bil-T: Total bilirubin; Bil-C: Conjugated bilirubin; HOMA-IR: Homeostatic model assessment of insulin resistance; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low density lipoprotein-cholesterol; TG: Triglycerides; CAP: Controlled attenuation parameter; TE: Transient elastography; L/A ratio: Leptin-to-adiponectin ratio; IQR: Interquartile range.
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Table 5 Clinical and biochemical parameters in primary biliary cholangitis patients with and without advanced liver fibrosis, mean ± SD/median (interquartile range)
PBC/no advFib
PBC/advFib
P value
Number of patients, n (%)62 (76.50)19 (23.50)
Age (years)63.60 ± 10.2065.10 ± 10.000.5411
BMI26.40 ± 5.1028.20 ± 5.600.2141
Waist circumference (cm)88.70 ± 12.4094.0 ± 15.000.1231
AST (% of ULN)78.33 (IQR 34.16)90.00 (IQR 71.67)0.0393
ALT (% of ULN)71.67 (IQR 50.00)63.33 (IQR 38.33)0.4063
GGT (% of ULN)112.70 (IQR 133.34)142.86 (IQR 266.67)0.1953
ALP (% of ULN)92.50 (IQR 49.30)92.50 (IQR 47.00)0.8883
Bil-T (μmol/L)11.20 (IQR 5.50)17.50 (IQR 16.80)0.0013
Bil-C (μmol/L)2.22 (IQR 1.42)3.99 (IQR 3.52)0.0013
Glucose (mmol/L)5.10 (IQR 1.00)5.70 (IQR 2.00)0.0033
C-peptide (ng/mL)1.68 (IQR 1.23)2.27 (IQR 1.19)0.0313
HOMA-IR4.70 (IQR 1.81)6.43 (IQR 4.59)0.0033
TC (mmol/L)5.43 ± 1.244.88 ± 1.090.0891
HDL-C (mmol/L)1.73 ± 0.421.47 ± 0.430.0221
LDL-C (mmol/L)3.46 (IQR 1.12)2.99 (IQR 1.28)0.2212
Ferritin (mg/L)76.90 (IQR 81.50)52.65 (IQR 65.30)0.8492
TG (mmol/L)1.06 (IQR 0.51)1.05 (IQR 0.62)0.4763
Platelets (× 109/L)250 (IQR 86.50)175.5 (IQR 153.70)< 0.0013
Adiponectin (pg/mL)1955.46 (IQR 2663.73)1782.70 (IQR 1854.27)0.7562
Leptin (ng/mL)1.09 (IQR 1.64)1.12 (IQR 1.89)0.5152
CAP (dB/m)216.00 (IQR 67)259.00 (IQR 82)0.2092
Liver stiffness (TE, kPa)5.60 (IQR 2.75)14.95 (IQR 7.70)< 0.0012
L/A ratio0.46 (IQR 1.33)1.05 (IQR 2.07)0.4822
1Independent T-test.
2Independent T-test after log-transformed.
3Mann-Whitney U test.
Advanced fibrosis was associated with higher bilirubin, aspartate aminotransferase levels, and homeostatic model assessment of insulin resistance, but not with leptin or adiponectin. Values are presented as raw (untransformed) data, statistical tests were performed on log-transformed values where indicated. PBC: Primary biliary cholangitis; AdvFib: Advanced fibrosis; BMI: Body mass index; AST: Aspartate aminotransferase; ULN: Upper limit of normal; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Bil-T: Total bilirubin; Bil-C: Conjugated bilirubin; HOMA-IR: Homeostatic model assessment of insulin resistance; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low density lipoprotein-cholesterol; TG: Triglycerides; CAP: Controlled attenuation parameter; TE: Transient elastography; L/A ratio: Leptin-to-adiponectin ratio; IQR: Interquartile range.
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Table 6 Comparison of adipokines and metabolic markers in primary biliary cholangitis patients stratified by biochemical response, mean ± SD/median (interquartile range)
PBC/ no CBR
PBC/CBR
P value
Number of patients, n (%)35 (43.80)45 (56.30)
Age (years)63.00 ± 8.7064.70 ± 11.100.5451
BMI27.10 ± 5.7026.70 ± 4.900.7511
Waist circumference (cm)88.90 ± 13.9090.60 ± 12.500.6501
AST (% of ULN)83.33 (IQR 158.33)78.33 (IQR 51.57)0.2733
ALT (% of ULN)66.67 (IQR 40.00)71.67 (IQR 58.34)0.4703
GGT (% of ULN)126.98 (IQR 223.81)109.52 (IQR 104.77)0.0623
ALP (% of ULN)117.50 (IQR 75.00)78.00 (IQR 31.30)< 0.0013
Bil-T (μmol/L)11.30 (IQR 16.00)12.2 (IQR 5.5)0.3423
Bil-C (μmol/L)2.66 (IQR 3.35)2.36 (IQR 1.42)0.2163
Glucose (mmol/L)5.30 (IQR 0.90)5.30 (IQR 1.30)0.8123
C-peptide (ng/mL)1.84 (IQR 1.63)1.90 (IQR 1.12)0.7343
HOMA-IR5.13 (IQR 3.63)4.75 (IQR 1.85)0.0863
TC (mmol/L)5.51 ± 1.185.15 ± 1.240.2071
HDL-C (mmol/L)1.74 ± 0.441.62 ± 0.420.3081
LDL-C (mmol/L)3.48 (IQR 1.01)3.33 (IQR 1.28)0.1302
Ferritin (mg/L)60.15 (IQR 54.30)83.40 (IQR 122.5)0.3042
TG (mmol/L)1.05 (IQR 0.51)1.09 (IQR 0.53)0.8543
Platelets (× 109/L)260 (IQR 151)230 (IQR 81)0.9963
Adiponectin (pg/mL)1998.77 (IQR 2537.98)1769.42 (IQR 2447.19)0.6942
Leptin (ng/mL)1.95 ± 2.531.95 ± 3.460.9022
CAP (dB/m)218.00 (IQR 62)247.00 (IQR 82)0.2342
Liver stiffness (TE, kPa)7.20 (IQR 8.60)6.20 (IQR 3.85)0.0222
L/A ratio0.68 (IQR 1.32)0.47 (IQR 1,77)0.6572
1Independent T-test.
2Independent T-test after log-transformed.
3Mann-Whitney U test.
No significant differences in adipokines were observed between responders and non-responders, except for alkaline phosphatase levels. Values are presented as raw (untransformed) data, statistical tests were performed on log-transformed values where indicated. PBC: Primary biliary cholangitis; CBR: Complete biochemical response; BMI: Body mass index; AST: Aspartate aminotransferase; ULN: Upper limit of normal; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Bil-T: Total bilirubin; Bil-C: Conjugated bilirubin; HOMA-IR: Homeostatic model assessment of insulin resistance; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low density lipoprotein-cholesterol; TG: Triglycerides; CAP: Controlled attenuation parameter; TE: Transient elastography; L/A ratio: Leptin-to-adiponectin ratio; IQR: Interquartile range.
Full Size Table
Table 7 Results of multivariate logistic regression predicting advanced fibrosis
Variable
B
SE
Wald
df
P value
Exp(B)
95%CI lower
95%CI upper
Log L/A ratio0.0180.2130.00710.9341.0180.6701.545
BMI (kg/m2)0.0550.0610.83110.3621.0570.9381.191
Age (years)0.0220.0310.50210.4781.0220.9621.085
CBR-1.2990.5815.00910.0250.2730.0870.851
Constant-3.4892.5431.88210.1700.031--
CI: Confidence interval; BMI: Body mass index; CBR: Complete biochemical response; L/A ratio: Leptin-to-adiponectin ratio.
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