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Changing aetiology of liver dysfunction in the new generation of a hepatitis B and C-endemic area: cross-sectional studies on adolescents born in the first 10 years after universal hepatitis B vaccination

Authors

  • Jung-Ta Kao,

    1. Department of Internal Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Jing-Houng Wang,

    1. Department of Internal Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chao-Hung Hung,

    1. Department of Internal Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Tsung-Hui Hu,

    1. Department of Internal Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chuan-Mo Lee,

    1. Department of Internal Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Shu-Fen Hung,

    1. Department of Internal Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Sheng-Nan Lu

    1. Department of Internal Medicine, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Correspondence
Sheng-Nan Lu MD, MPH, PhD, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Division of Hepato-Gastroenterology, #123 Ta Pei Road, Niao Sung 833, Kaohsiung, Taiwan
Tel: +886 7 731 7123, ext. 8301
Fax: +886 7 732 2402
e-mail: juten@ms17.hinet.net

Abstract

Background/Aim: Geographical variation in viral hepatitis infection complicates various levels of liver diseases. This study elucidates the changing aetiology of alanine transaminase elevation (ALT levels >40 IU/L) in a previously hepatitis-endemic township.

Design/Methods: Five cross-sectional screenings were performed on teenagers born from 1984 to 1993. We examined hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (anti-HCV), ALT and body mass index, and additionally checked hepatitis B envelope antigen (HBeAg) for positive HBsAg and HCV RNA for positive anti-HCV. Teenagers with ALT elevation underwent an ultrasonography examination.

Results: This study enrolled 1788 (93.7%) of 1909 students, discovering individual prevalence of HBsAg (6.3%), anti-hepatitis B core (anti-HBc) (15.5%), anti-HCV (2.2%), overweight (22.4%), obesity (12.8%) and ALT >40 IU/L (3.7%). HBsAg and anti-HBc prevalence declined with trends, while obesity increased with trends (P<0.001). Among 66 ALT-elevated teenagers, prevalence percentages of risk factors were HBsAg (22.7%), anti-HCV (1.5%), obesity (45.5%), HBsAg with obesity (7.6%) and anti-HCV with obesity (3.0%). Additionally, obesity showed predominance (85.7%) among aetiologies of teenagers with fatty livers (60.9%). The independently associated factors of ALT elevation included being male (odds ratio, 2.18; 95% confidence interval, 1.21–3.93), HBsAg (4.25; 1.06–17.13), HBeAg (7.24; 1.64–31.9), HCV RNA (29.03; 5.8–145.29) and obesity (16.5; 8.79–30.98).

Conclusion: In place of viral hepatitis, obesity is becoming the major aetiology of abnormal liver function among the young generation in a previously hepatitis-endemic area.

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