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Updated: Jul 3, 2026
Mouse Models Of Helicobacter Infection And Gastric Pathologies
Published on: October 18, 2018
Helicobacter pylori and metabolic-associated fatty liver disease severity: a meta-analysis
Lingyun Zhang1, Yuexia Zhang2, Lei Qiao1
1Department of Gastroenterology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Background And Aims:
Metabolic-associated fatty liver disease (MAFLD) is a global health concern. Observational evidence has suggested a possible relationship between Helicobacter pylori infection and MAFLD severity; however, severity-focused data remain inconsistent and methodologically heterogeneous.
Methods:
We searched the international databases PubMed, Embase and Web of Science and the Chinese databases China National Knowledge Infrastructure, Chinese Scientific Journal Database (VIP) and Wanfang between January 2015 and December 2024. Observational studies reporting H. pylori status and MAFLD/non-alcoholic fatty liver disease (NAFLD) severity were included. Studies using NAFLD criteria were considered clinically comparable with MAFLD because they were conducted before the broad adoption of the MAFLD terminology and enrolled fatty liver disease populations defined by hepatic steatosis with metabolic features. Pooled odds ratios (ORs) were calculated using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment.
Results:
Seven studies, comprising 11,168 participants (4,980 H. pylori-positive; 6,188 H. pylori-negative), were included. The overall random-effects analysis did not demonstrate a statistically significant association between H. pylori infection and MAFLD severity (pooled OR 1.47, 95% confidence interval [CI]: 0.83-2.59, p = 0.148; τ 2 = 0.1325), with substantial heterogeneity (I 2 = 79.0%). In the non-invasive assessment subgroup, the pooled estimate was OR = 1.22 (95% CI: 0.95-1.57). The two biopsy-based studies showed high but highly imprecise individual estimates and were not interpreted as evidence of a stronger association. Geographic analysis showed an association only in Chinese populations (OR = 1.31, 95% CI: 1.15-1.49, I 2 = 0%).
Conclusion:
Current evidence does not demonstrate a statistically significant overall association between H. pylori infection and MAFLD severity. A modest association was observed in Chinese studies, although biopsy-based evidence remains too imprecise for inference. Large-scale prospective studies with standardized assessment of active H. pylori infection and MAFLD severity are needed before causal or therapeutic conclusions can be drawn.
Insights
Helicobacter pylori infection is not significantly linked to metabolic-associated fatty liver disease (MAFLD) severity overall. However, a modest association was found in Chinese populations, warranting further investigation.
Area of Science:
- Hepatology
- Gastroenterology
- Infectious Diseases
Background:
- Metabolic-associated fatty liver disease (MAFLD) is a growing global health issue.
- Previous observational studies suggested a link between Helicobacter pylori (H. pylori) infection and MAFLD severity, but findings were inconsistent.
- Methodological heterogeneity in prior research complicated definitive conclusions.
Purpose of the Study:
- To systematically evaluate the association between H. pylori infection and the severity of metabolic-associated fatty liver disease (MAFLD).
- To synthesize existing evidence from observational studies to clarify the relationship between H. pylori and MAFLD progression.
Main Methods:
- A comprehensive literature search was conducted across major international and Chinese databases (PubMed, Embase, Web of Science, CNKI, VIP, Wanfang) from January 2015 to December 2024.
- Seven observational studies involving 11,168 participants were included, analyzing H. pylori status and MAFLD/NAFLD severity.
- Random-effects models were employed to calculate pooled odds ratios (ORs), accounting for study heterogeneity.
Main Results:
- The overall meta-analysis did not reveal a statistically significant association between H. pylori infection and MAFLD severity (OR 1.47, p=0.148), with substantial heterogeneity (I²=79.0%).
- Subgroup analysis of non-invasive assessments showed a pooled OR of 1.22 (95% CI: 0.95-1.57).
- A significant association was observed specifically in Chinese populations (OR 1.31, 95% CI: 1.15-1.49) with no heterogeneity (I²=0%), while biopsy-based evidence was imprecise.
Conclusions:
- Current evidence does not support a significant overall association between H. pylori infection and MAFLD severity.
- A modest association was noted in Chinese populations, but biopsy data remain inconclusive.
- Large-scale prospective studies with standardized assessments are required to establish causality or therapeutic implications.
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