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This study aimed to assess liver fibrosis in CHB patients with concurrent MAFLD. This cross-sectional study included 148 patients with a confirmed diagnosis of CHB infection, categorized according to the MAFLD standard criteria into CHB with MAFLD (CHB\/+MAFLD) and without MAFLD (CHB\/\u2212MAFLD). Demographic, metabolic, and biochemical parameters were analyzed. Fibrosis was assessed non-invasively using vibration-controlled transient elastography (VCTE). A multivariate logistic regression identified independent predictors of significant fibrosis. Among the CHB cohort, 34.5% fulfilled MAFLD criteria. Using FIB-4\u2009&gt;\u20091.3 for significant fibrosis, the CHB\/+MAFLD group exhibited a higher prevalence of significant fibrosis 45.1% vs. 23.7% in the CHB\/\u2212MAFLD group, with higher medians in the CHB\/+MAFLD group (1.2 vs. 0.8,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Using liver stiffness measurement (LSM), those with MAFLD had a higher prevalence of significant fibrosis (F\u2009\u2265\u20092; 37.3 vs. 16.5%,\n                    <jats:italic>p<\/jats:italic>\n                    0.005) than in those without MAFLD (medians 6.1 and 5.6\u00a0kPa, respectively,\n                    <jats:italic>p<\/jats:italic>\n                    0.03). In multivariate analysis, MAFLD independently increased the odds of significant fibrosis (4.48, 95% CI 1.29\u201315.6,\n                    <jats:italic>p<\/jats:italic>\n                    0.019) in CHB patients. The interplay of MAFLD and CHB is associated with worsening liver injury and fibrosis progression. Given the high prevalence of MAFLD and negative impact, metabolic risk assessment should be incorporated into routine CHB care to reduce fibrosis and improve long-term liver outcomes.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-58144-3","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:27:04Z","timestamp":1782383224000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The coexistence of MAFLD increases fibrosis burden in patients with chronic hepatitis B"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1237-8428","authenticated-orcid":false,"given":"Alaa Mohamed","family":"Mostafa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Fouad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia Abdelaaty","family":"Abdelkader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Magdy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehal Refaat","family":"Raouf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Eslam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"issue":"8","key":"58144_CR1","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1038\/s41575-023-00760-9","volume":"20","author":"YC Hsu","year":"2023","unstructured":"Hsu, Y. 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