Relationship between Helicobacter pylori infection and risk of metabolic dysfunction-associated steatotic liver disease: An updated meta-analysis

Alessandro Mantovani; Maria Giovanna Lando; Nicolò Borella; Enrico Scoccia; Barbara Pecoraro; Federico Gobbi; Zeno Bisoffi; Luca Valenti; Herbert Tilg; Christopher D Byrne; Giovanni Targher

doi:10.1111/liv.15925

Relationship between Helicobacter pylori infection and risk of metabolic dysfunction-associated steatotic liver disease: An updated meta-analysis

Liver Int. 2024 Apr 3. doi: 10.1111/liv.15925. Online ahead of print.

Authors

Affiliations

¹ Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
² Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
³ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁴ Precision Medicine-Biological Resource Center, Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.
⁵ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
⁶ Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria.
⁷ National Institute for Health and Care Research, Southampton Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton, UK.
⁸ Department of Medicine, University of Verona, Verona, Italy.
⁹ Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.

PMID: 38567962
DOI: 10.1111/liv.15925

Abstract

Background: Recent observational studies examining the association between Helicobacter pylori infection and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) have reported conflicting results. We performed a meta-analysis to quantify the magnitude of the association between H. pylori infection and the risk of MASLD.

Methods: We systematically searched three large electronic databases to identify eligible observational studies (published up to 30 November 2023) in which liver biopsy, imaging methods or blood-based biomarkers/scores were used for diagnosing MASLD. Data from selected studies were extracted, and meta-analysis was performed using common and random-effects modelling. Statistical heterogeneity among published studies, subgroup analyses, meta-regression analyses and publication bias were assessed.

Results: A total of 28 observational studies (24 cross-sectional and 4 longitudinal studies) were identified, including 231 291 middle-aged individuals of predominantly Asian ethnicity (~95%). Meta-analysis of cross-sectional studies showed that H. pylori infection was significantly associated with a small increase in the risk of prevalent MASLD (n = 24 studies; random-effects odds ratio 1.11, 95% CI 1.05-1.18; I² = 63%). Meta-analysis of data from longitudinal studies showed that H. pylori infection was significantly associated with an increased risk of developing incident MASLD over a mean 5-year follow-up (n = 4 studies; random-effects odds ratio 1.20, 95%CI 1.08-1.33; I² = 44%). Sensitivity analyses did not modify these results. The funnel plot did not reveal any significant publication bias.

Conclusions: H. pylori infection is associated with a mildly increased risk of prevalent and incident MASLD. Further well-designed prospective and mechanistic studies are required to better decipher the complex link between H. pylori infection and the risk of MASLD.

Keywords: Helicobacter pylori; MASLD; NAFLD; metabolic dysfunction‐associated steatotic liver disease; non‐alcoholic fatty liver disease.

Publication types

Review