Serum HBV surface antigen positivity is associated with low prevalence of metabolic syndrome: A meta-analysis

BACKGROUND AND AIM As there is conflicting evidence for the relationship between hepatitis B virus surface antigen (HBsAg) positivity and the prevalence of metabolic syndrome (MetS), we performed a meta-analysis to investigate whether HBsAg positivity affects the incidence of MetS. METHODS Observational studies on the relationship between HBsAg positivity and MetS were obtained from PubMed, Web of Science, and the Cochrane Library in April 2016. The pooled odds ratios (ORs) of MetS and its components (central obesity, increased fasting glucose, increased blood pressure, dyslipidemia) for subjects with or without HBsAg positivity were synthesized. The standardized mean difference of MetS components between HBsAg-positive participants and healthy controls was calculated. Heterogeneity was explored with subgroup analysis and sensitivity analysis. Publication bias was detected using Egger's test and Begg's test. RESULTS Thirty studies were eligible for meta-analysis. The MetS OR for HBsAg-positive participants was significantly decreased compared with the controls [OR = 0.80, 95% confidence interval (CI), 0.70-0.90]. The negative effect of HBsAg positivity on elevated triglycerides (OR = 0.62, 95% CI, 0.59-0.64) was strong, while that for increased fasting blood glucose was weak (OR = 0.94, 95% CI, 0.90-0.98). The pooled ORs of central obesity (OR = 0.97, 95% CI, 0.91-1.04), reduced high-density lipoprotein cholesterol (OR = 0.98, 95% CI, 0.83-1.14), and elevated blood pressure (OR = 1.00, 95% CI, 0.80-1.25) for HBsAg-positive participants were all not significantly different compared with the controls. No publication bias was detected. CONCLUSIONS Serum HBsAg positivity is inversely associated with the prevalence of MetS. Among the five components of MetS, elevated triglycerides had the strongest inverse relationship with HBsAg positivity.