A Meta-analysis of the association between Helicobacter pylori infection and non-alcoholic fatty liver disease
Objective To evaluate the association between Helicobacter pylori(H.pylori)infection and non-alcoholic fatty liver disease(NAFLD).Methods English databases including PubMed,EmBase,Web of Science and the Cochrane Library,along with Chinese databases such as CBM,CNKI,WanFang Data and VIP,were systematically searched to gather studies investigating the association between H.pylori infection and NAFLD.The search spanned from the inception of each database up to Jul.2022.Two researchers independently screened literature,extracted data and assessed the risk of bias in the included studies.Meta-analysis was conducted using RevMan 5.4 software.The inverse variance method was employed to pool odds ratio(OR)values and their 95%CI,with subgroup and sensitivity analyses carried out.Results Twenty-three studies were included,comprising 2 cohort studies,2 case-control studies and 19 cross-sectional studies,involving a total of 233 393 subjects.H.pylori infection exhibited a positive association with an increased risk of NAFLD(OR=1.24,95%CI:1.14-1.35,P<0.00001).Subgroup analyses based on H.pylori de-tection methods consistently demonstrated higher incidence of NAFLD in the H.pylori-positive group compared to the H.pylori-negative group across various subgroups including serological detection,ultrasound,liver biopsy,hepatic steatosis index and study design(P≤0.05).Similarly,subgroup analyses based on NAFLD diagnosis methods indica-ted higher H.pylori infection rates in the NAFLD group compared to healthy controls across different diagnostic modali-ties and study designs(P<0.05).Sensitivity analysis confirmed the stability of the results,although publication bias was suggested by funnel plot asymmetry.Conclusion Current evidence suggests a heightened risk of NAFLD develop-ment in individuals with H.pylori infection compared to those without,and a higher prevalence of H.pylori infection in NAFLD patients compared to healthy controls.However,given limitations in the quality and design of included studies,further high-quality prospective research is warranted to elucidate the causal relationship between H.pylori infection and NAFLD.
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