Differential NMR Lipoprotein Profiles and Prediction of Insulin Resistance and Metabolic Syndrome by LP-IR Among Adult Chronic Hepatitis B Patients

<b>Background/Objectives</b>: Chronic hepatitis B and metabolic dysfunction-associated steatotic liver disease (MASLD) are associated with risk of advanced hepatic fibrosis and cirrhosis. Given the increased risk, the presence of insulin resistance, metabolic syndrome, and hepatic fibrosis should be assessed in individuals with chronic hepatitis B. The Lipoprotein Insulin Resistance Index (LP-IR) is a simple method of assessing insulin resistance in the general population, and lipoprotein profiles have been shown to reflect hepatic steatosis and fibrosis in patients with MASLD. However, LP-IR and lipoprotein profiles have not been evaluated in patients with chronic hepatitis B. <b>Methods</b>: Lipoprotein profiles and LP-IR scores were evaluated in a cohort of patients with chronic hepatitis B using NMR spectroscopy. <b>Results</b>: Serum samples from 50 patients with chronic hepatitis B and 44 with chronic hepatitis B and metabolic syndrome were analyzed. A cut-off value was defined that differentiates patients with and without insulin resistance. Increased large VLDL and reduced small VLDL particles were observed, suggesting the presence of hepatic steatosis and fibrosis. <b>Conclusions</b>: In this largely Asian cohort of chronic hepatitis B patients, where BMI and conventional markers are less reliable, LP-IR scores differentiated patients with and without insulin resistance and metabolic syndrome. In addition, distinctive lipoprotein profiles such as increased large VLDL and reduced small VLDL particles were observed in these chronic hepatitis B patients, suggesting the presence of hepatic steatosis and fibrosis. Future studies with larger sample sizes are necessary to confirm the utility of these NMR-measured lipoprotein parameters in predicting metabolic disease and fibrosis among patients with underlying liver disease.