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Review
. 2021 Aug 6;100(31):e26706.
doi: 10.1097/MD.0000000000026706.

Relationship between Helicobacter pylori infection and nonalcoholic fatty liver disease: What should we expect from a meta-analysis?

Lin Wei  1 , Hui-Guo Ding
Affiliations
Review

Relationship between Helicobacter pylori infection and nonalcoholic fatty liver disease: What should we expect from a meta-analysis?

Lin Wei et al. Medicine (Baltimore). .

Abstract

Background: The relationship between Helicobacter pylori (H. pylori) infection and nonalcoholic fatty liver disease (NAFLD) is a matter of debate. Although it has been studied in many observational studies, the results remain controversial. Therefore, we performed a meta-analysis to assess the association between H pylori infection and risk of NAFLD.

Methods: We searched Pubmed, EMBASE, and Web of Science databases, from inception to September 10, 2020. Odds ratio (OR) and 95% confidence interval (CI) were pooled by random-effects model. The statistical heterogeneity among studies (I2-index), subgroup analyses, regression analyses, sensitivity analysis and the possibility of publication bias were assessed.

Results: A total of seventeen studies involving 91,958 individuals were included in our meta-analysis. Meta-analysis of data from cross-sectional and case-control studies showed that H pylori infection was associated with increased risk of prevalent NAFLD (n = 15; involving 74,561 middle-aged individuals; OR1.38, 95% CI 1.23-1.55, I2 = 86.8%, P < .001). The results of meta-regression implicated that the study type and the case-control ratio impacted the total effect size. Funnel plot did not show significant publication bias. Meta-analysis of data from longitudinal studies showed that H pylori infection was also associated with increased NAFLD incidence (n = 2; involving 17397 individuals; OR 1.21, 95% CI 1.01-1.44, I2 = 6.5%, P = .301).

Conclusions: The results indicated that a positive association between H pylori infection and the risk of NAFLD. Further studies are required to strengthen the association and clarify the mechanism.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A flow diagram of the literature search and PRISMA.
Figure 2
Figure 2
The result of quality assessment according to the Agency for Healthcare Research and Quality (AHRQ) for cross-sectional studies.
Figure 3
Figure 3
(A) The forest plot and pooled estimates of the effect of H pylori infection on the risk of prevalent NAFLD in cross-sectional or case-control studies. (B) The forest plot and pooled estimates of the effect of H pylori infection on the risk of prevalent NAFLD in longitudinal studies; CI = confidence interval, H pylori = Helicobacter pylori, NAFLD = nonalcoholic fatty liver disease, OR = odds ratio.
Figure 4
Figure 4
(A) The meta-regression analysis of study type. (B)The meta-regression analysis of case/control ratio.
Figure 5
Figure 5
The sensitivity analysis using the one-study remove (leave-one-out) approach in order to examine the influence of each study on the overall effect size.
Figure 6
Figure 6
(A) Funnel plot of association between H pylori infection and NAFLD, (B) Begg's tests to quantify the publication bias; CI = confidence interval, NAFLD = nonalcoholic fatty liver disease, OR = odds ratio.
See this image and copyright information in PMC

References

    1. Fazel Y, Koenig AB, Sayiner M, Goodman ZD, Younossi ZM. Epidemiology and natural history of non-alcoholic fatty liver disease. Metabolism 2016;65:1017–25. - PubMed
    1. Lonardo A, Bellentani S, Argo CK, et al. Epidemiological modifiers of non-alcoholic fatty liver disease: focus on high-risk groups. Dig Liver Dis 2015;47:997–1006. - PubMed
    1. Younossi Z, Anstee QM, Marietti M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018;15:11–20. - PubMed
    1. Wong MCS, Huang JLW, George J, et al. The changing epidemiology of liver diseases in the Asia-Pacific region. Nat Rev Gastroenterol Hepatol 2019;16:57–73. - PubMed
    1. Younossi Z, Tacke F, Arrese M, et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology 2019;69:2672–82. - PubMed