Overweight and Helicobacter pylori Infection: A Correlation in Metabolic Dysfunction-Associated Fatty Liver Disease

Xu Chen¹Jiayue Fu²Kejia Jin¹Zixuan Yang¹Yi Dan Qian¹Kehan Mei²Yihan Wang²Jialei Min²Yilin Du²Zhu Zaisheng^3*Li Shengcun^4,5*

• ¹Department of Medical Care Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
• ²School of Information and Engineering, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
• ³Department of General Medicine, The First Affiliated Hospital of Wenzhou Medical University, ,Wenzhou, China
• ⁴Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
• ⁵Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), School of Pharmaceutical Science, Wenzhou Medical University,, Wenzhou, China

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) has recently replaced nonalcoholic fatty liver disease (NAFLD) as a term that more accurately describes its pathogenesis. Helicobacter pylori (H. pylori), a bacterium that infects over half the world's population, has been increasingly linked to various extragastric diseases. However, the impact of H. pylori on MAFLD in the Chinese population remains unexplored.A retrospective cross-sectional study was conducted, encompassing 5619 participants from the First Affiliated Hospital of Wenzhou Medical University, spanning from April 2016 to August 2017. Detection of H. pylori was achieved through the 13 C urea breath test or gastric biopsies with histochemical staining. Fatty liver was primarily diagnosed via ultrasound and assessed alongside metabolic indicators to confirm MAFLD. Logistic regression was utilized to evaluate the association between H. pylori and MAFLD.Results: No significant correlation between H. pylori infection and MAFLD was found in the overall population through either univariate (OR=1.136, 95%CI 0.995-1.297, p=0.059) or multivariate logistic regression analysis (OR=1.036, 95%CI 0.877-1.224, p=0.675). However, subgroup analysis revealed a significant association in overweight individuals (BMI ≥ 23 kg/m 2 ) within the MAFLD group (51.2% vs. 35.5%, p=0.002), a pattern not observed in the non-MAFLD group (47.7% vs. 45.4%, p=0.126). This association persisted after adjusting for confounders (OR=1.957, p=0.010).Overweight individuals with MAFLD have a higher prevalence of H. pylori infection than their lean counterparts. This suggests a detrimental cycle between overweight status and H. pylori infection in MAFLD patients, potentially exacerbating metabolic deterioration. Therefore, eradication of H. pylori infection may have positive implications for reducing the incidence rate of overweight MAFLD.