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

Sana Barakat1, Mohamed Abdel-Fadeel1, Ola Sharaki2

  • 1Paediatric Department, Faculty of Medicine, Alexandria University, Champollion Street El-Khartoum Square, Azarita Medical Campus 21311, Alexandria, Egypt.

European Journal of Pediatrics
|November 27, 2024
PubMed

Insights

Helicobacter pylori infection is linked to a higher risk of non-alcoholic fatty liver disease (NAFLD) in children. This bacterial infection, particularly with Cag A strains, is associated with increased NAFLD severity and grade.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Microbiology

Background:

  • Non-alcoholic fatty liver disease (NAFLD) is increasingly prevalent in children, linked to rising pediatric obesity rates.
  • Insulin resistance and dyslipidemia are key factors in NAFLD development, often explained by the gut-liver axis.
  • Helicobacter pylori (H. pylori) infection is being investigated for its potential role in pediatric NAFLD.

Purpose of the Study:

  • To investigate the association between H. pylori infection and NAFLD in children.
  • To determine the relationship between H. pylori infection and the grade of NAFLD.
  • To identify predictors of NAFLD and factors influencing its grade in pediatric cases.

Main Methods:

  • A case-control study involving 100 children with NAFLD and 100 controls, all assessed for H. pylori stool antigen.
  • Serum analysis for H. pylori specific antibodies (Cag A, Vac A, Gro EL, HCPC, Ure A) in infected individuals.
  • Regression analysis to identify predictors of NAFLD and factors associated with NAFLD grade.

Main Results:

  • H. pylori infection was significantly more common in children with NAFLD (64%) compared to controls (25%).
  • H. pylori Cag A and Vac A positivity were higher in NAFLD children.
  • H. pylori positivity (OR=5.02), Homa IR (OR=18.84), waist percentile (OR=1.18), and triglycerides (OR=1.03) predicted NAFLD.
  • Cag A positivity was linked to higher NAFLD grade (grade 2).

Conclusions:

  • H. pylori infection may increase the risk of developing NAFLD in children.
  • H. pylori infection, particularly with Cag A strains, is associated with more severe NAFLD.
  • Triglycerides, waist circumference, and Homa IR are independent predictors of pediatric NAFLD.

Keywords:
Helicobacter pyloriCytotoxin-associated gene ANon-alcoholic fatty liver diseaseVacuolating cytotoxin A

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