Wong GLH, et al 1 Metabolic Syndrome Increases the Risk of Liver Cirrhosis in Chronic Hepatitis B Short title: Metabolic Syndrome and Cirrhosis

Abbreviations: ALT = alanine aminotransferase, BMI = body-mass index, CHB = chronic hepatitis B, CHC = chronic hepatitis C, CI = confidence intervals, HBeAg = hepatitis B e antigen, HBsAg = hepatitis B surface antigen, IDF = International Diabetes Federation, kPa = kilopascal, LSM = liver stiffness measurement, NAFLD = nonalcoholic fatty liver disease, ROC = receiver operating characteristics Background: Metabolic syndrome is associated with nonalcoholic steatohepatitis and cryptogenic cirrhosis. Whether metabolic syndrome affects the severity of chronic hepatitis B (CHB) is unclear. Aim: We aimed to study the relationship between metabolic syndrome and the risk of liver cirrhosis in CHB patients. Methods: We prospectively recruited CHB patients from primary care and hospital clinics for liver stiffness measurement (LSM) with transient elastography to diagnose early cirrhosis. Probable cirrhosis was defined as LSM ≥13.4kPa. We analyzed a subgroup of patients with paired LSM and liver biopsies to validate the accuracy of LSM. Results: One thousand four hundred and sixty-six patients had reliable LSM and 134 (9%) patient