Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2016; 22(8): 2592-2600
Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2592
Helicobacter pylori infection is not associated with nonalcoholic fatty liver disease
Myong Ki Baeg, Seung Kew Yoon, Sun-Hye Ko, Yong-Sun Noh, In-Seok Lee, Myung-Gyu Choi
Myong Ki Baeg, Seung Kew Yoon, Sun-Hye Ko, Yong-Sun Noh, In-Seok Lee, Myung-Gyu Choi, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul 137-701, South Korea
Author contributions: Baeg MK and Ko SK designed the research; Baeg MK and Noh YS performed the research; Ko SK and Lee IS analyzed the data; Baeg MK, Yoon SK and Ko SK wrote the manuscript; Yoon SK, Lee IS and Choi MG edited the manuscript.
Institutional review board statement: This study was reviewed and approved by Seoul St. Mary’s Hospital Institutional Review Board, No. KC12RISI0317.
Informed consent statement: No consent statements were needed in carrying out this manuscript as this was a retrospective study using blinded records. The Institutional Review Board of The Catholic Medical Center approved the waiving of informed consent forms.
Conflict-of-interest statement: No conflicts of interest were reported for all authors.
Data sharing statement: The original, blinded data are available from the corresponding author at yoonsk@catholic.ac.kr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seung Kew Yoon, MD, PhD, Department of Internal Medicine, The Catholic University of Korea College of Medicine, 222 Banpodaero, Seochogu, Seoul 137-701, South Korea. yoonsk@catholic.ac.kr
Telephone: +82-2-22587534 Fax: +82-2-5369559
Received: October 3, 2015
Peer-review started: October 5, 2015
First decision: November 5, 2015
Revised: November 22, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: February 28, 2016
Processing time: 145 Days and 0.1 Hours
Abstract

AIM: To determine whether Helicobacter pylori (H. pylori) infection confers a higher risk of Nonalcoholic fatty liver disease (NAFLD).

METHODS: Healthy people who underwent health screening were analyzed retrospectively. Inclusion criteria were age ≥ 20 years, history of H. pylori infection, and recorded insulin level. Participants were classified as H. pylori positive or negative according to 13C urea breath tests. NAFLD was defined using the hepatic steatosis index (HSI) and NAFLD liver fat score (NAFLD-LFS). Those with an HSI > 36 or NAFLD-LFS > -0.640 were considered to have NAFLD. Multivariable logistic regression was performed to identify risk factors for NAFLD.

RESULTS: Three thousand six hundred and sixty-three people were analyzed and 1636 (44.7%) were H. pylori positive. H. pylori infection was associated with older age, male gender, hypertension, higher body mass index, and a dyslipidemic profile. HSI differed significantly between H. pylori positive and negative subjects (median 33.2, interquartile range (IQR) 30.0-36.2 for H. pylori-positive vs median 32.6, IQR 29.8-36.0 for negative participants, P = 0.005), but NAFLD-LSF did not [median -1.7, IQR -2.4 - -0.7 vs median -1.8, IQR -2.4-(-0.7), respectively, P = 0.122]. The percentage of people with NAFLD did not differ between infected and uninfected groups: HIS, 26.9% vs 27.1%, P = 0.173; NAFLD-LFS, 23.5% vs 23.1%, P = 0.778. H. pylori infection was not a risk factor, but C-reactive protein concentration and smoking were significant risk factors for NAFLD.

CONCLUSION: H. pylori infection is not a risk factor for NAFLD as indicated by HSI or NAFLD-LFS. Prospective, large-scale studies involving liver biopsies should be considered.

Keywords: Helicobacter pylori; Nonalcoholic fatty liver disease; Hepatic steatosis index; Nonalcoholic fatty liver disease liver fat score; Urea breath test

Core tip: Nonalcoholic fatty liver disease (NAFLD) is a common disorder which affects 20%-45% of the general population. Helicobacter pylori (H. pylori) infection has been suggested as a contributing to NAFLD. We investigated the association between H. pylori infection and NAFLD by using two non-invasive scoring formula, NAFLD-fat score and hepatic steatosis index. Our study showed that H. pylori infection was not a risk factor for NAFLD by either formula. However, c-reactive protein and smoking were significant risk factors for NAFLD. Prospective studies involving liver biopsies should be carried out to further investigate the association between H. pylori infection and NAFLD.