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. 2024 Nov 27;184(1):47.
doi: 10.1007/s00431-024-05867-y.

Is Helicobacter pylori infection a risk factor for non-alcoholic fatty liver disease in children?

Sana Barakat  1 , Mohamed Abdel-Fadeel  1 , Ola Sharaki  2 , Mohamed El Shafei  3 , Basant Elbanna  4 , Aml Mahfouz  1
Affiliations

Is Helicobacter pylori infection a risk factor for non-alcoholic fatty liver disease in children?

Sana Barakat et al. Eur J Pediatr. .

Abstract

Helicobacter pylori infection has been investigated as a potential risk factor for non-alcoholic fatty liver disease (NAFLD). Some studies suggest a possible link between the two conditions. The purpose of this study is to study the relationship between H. pylori infection and NAFLD in pediatrics and its relation to NAFLD grades. A case-control study to identify predictors of NAFLD and a comparative cross-sectional approach to determine factors affecting NAFLD grades were adopted. One hundred NAFLD children (ultrasound-based) and a control group of 100 non-NAFLD children were recruited. Both groups were evaluated by detecting H. pylori stool antigen. Immunoglobulin G antibodies to Cag A (cytotoxin-associated gene A), Vac A (vacuolating cytotoxin A), Gro EL (chaperonin Gro EL), HCPC (Helicobacter cysteine-rich protein C), and Ure A (Urease subunit A) were assessed in the serum of those with positive stool antigen. H. pylori infection was significantly higher in NAFLD children compared to the control group (64% versus 25%, p-value < .001). (NAFLD children showed higher Cag A and Vac A positivity (34, 10%) versus (2%, 0%) in the control group, respectively, p-value < .001). The regression model showed that H. pylori positivity (OR (odds ratio) = 5.021, 95% CI (confidence interval): 1.105-22.815), homeostatic model assessment of insulin resistance (Homa IR) (OR = 18.840, 95% CI: 3.998-88.789), waist percentile (OR = 1.184, 95% CI: 1.044-1.344), and triglycerides (OR = 1.029, 95% CI: 1.012-1.047) were predictors for NAFLD. Cag A positivity (OR = 2.740, 95% CI: 1.013-7.411) was associated with higher NAFLD grade (grade 2 fatty liver).

Conclusions: H. pylori infection could increase the risk of NAFLD in children. Triglycerides, waist circumference, and Homa IR are significant independent predictors of NAFLD.

What is known: • NAFLD has become one of the most common liver diseases among children because of the increased prevalence of pediatric obesity. • Dyslipidemia and insulin resistance play a central role in NAFLD pathogenesis. • NAFLD could be explained by the multiple-hit hypothesis. The gut microbiota is an important factor in this hypothesis (gut liver axis).

What is new: • Helicobacter pylori infection could increase the risk of NAFLD in children. • H. pylori Cytotoxin-associated gene A (Cag A) positivity is associated with higher NAFLD grade.

Keywords: Helicobacter pylori; Cytotoxin-associated gene A; Non-alcoholic fatty liver disease; Vacuolating cytotoxin A.

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Conflict of interest statement

Declarations. Ethics approval: The research was approved by the Ethics Committee of the Faculty of Medicine – Alexandria University (17/11/2022) in accordance with ICH GCP (International Council for Harmonisation Good Clinical Practice) guidelines with registry number 0201736. Conflict of interest: The authors declare no competing interests.

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