Association between Helicobacter pylori infection and risk of nonalcoholic fatty liver disease: An updated meta-analysis

Abstract

Background: Recent studies that have examined the association between Helicobacter pylori infection and risk of nonalcoholic fatty liver disease (NAFLD) have produced conflicting data. We have performed a systematic review and meta-analysis to assess the association between H. pylori infection and risk of NAFLD. Methods: We searched PubMed, Web of Science and Scopus databases using predefined keywords to identify observational studies (published up to November 2018), in which NAFLD was diagnosed by histology, imaging or biochemistry. Data from selected studies were extracted and meta-analysis was performed using random-effects modeling. The statistical heterogeneity among studies (I 2-index), subgroup analyses and the possibility of publication bias were assessed. Results: Thirteen observational (11 cross-sectional/case-control and 2 longitudinal) studies involving a total of 81,162 middle-aged individuals of predominantly Asian ethnicity (47.5% of whom had H. pylori infection diagnosed by urea breath test, faecal or serological tests) were included in the final analysis. Meta-analysis of data from crosssectional and case-control studies showed that H. pylori infection was associated with increased risk of prevalent NAFLD (n=11 studies; random-effects odds ratio [OR] 1.20, 95%CI 1.07-1.35; I 2 =59.6%); this risk remained significant in those studies where analysis was fully adjusted for age, sex, smoking, adiposity measures, diabetes or dyslipidemia (random-effects OR 1.19, 95% CI 1.07-1.32, I 2 = 0%). Meta-analysis of data from longitudinal studies showed that H. pylori infection was also associated with increased NAFLD incidence (n=2 studies; random-effects hazard ratio 1.14, 95%CI 1.05-1.23; I 2 =0%). Sensitivity analyses did not alter these findings. Funnel plot did not reveal significant publication bias. Conclusions: H. pylori infection is associated with mildly increased risk of both prevalent and incident NAFLD in middle-aged individuals. More prospective studies, particularly in non-Asian populations, and mechanistic studies are required to better elucidate the link between chronic H. pylori infection and NAFLD.

Active Helicobacter pylori Infection is Independently Associated with Nonalcoholic Steatohepatitis in Morbidly Obese Patients

“…Subsequently, other studies reported a positive association between Hp-I and NAFLD, including those of Yu et al [19], Sumida et al [38], Okushin et al [18], Kim et al [10,27], Zhang et al [21], Chen et al [26], Dogan et al [25], Abdel-Razik et al [24], and Kang et al [11]. Noteworthy, there have been five systematic reviews performed with meta-analysis, all of which revealed a positive association between the pathologies of interest [39][40][41][42][43]. Nonetheless, there are studies showing no association between Hp-I and NAFLD [14,15,19,20,22].…”

<p>Relationship Between <em>Helicobacter pylori</em> Infection and Nonalcoholic Fatty Liver Disease (NAFLD) in a Developing Country: A Cross-Sectional Study</p>

“…22 Meta-analysis of data from longitudinal studies showed that H. pylori infection was also associated with increased NAFLD incidence. 28 The pooled results from 12 studies indicated a higher risk of NAFLD in patients infected with H. pylori. 29 Helicobacter pylori infection may be an independent risk factor in NAFLD progress.…”

Associations between Helicobacter pylori with nonalcoholic fatty liver disease and other metabolic conditions in Guatemala

“…Recent evidence has suggested that H pylori is associated with the development of NAFLD 7‐11 . Several meta‐analyses, predominantly from studies of Asian populations, have reported H pylori infection‐NAFLD associations with pooled odds ratios ranging between 1.14 and 1.53 12‐16 …”