Metabolic Syndrome and Its Components Are Associated with Closed-Type Endoscopic Atrophic Gastritis in a Large...

In recent studies, metabolic syndrome (MetS) has been identified as a risk factor for gastric cancer. To enhance risk stratification protocols and prevention for gastric cancer, we sought to determine whether MetS was associated with atrophic gastritis (AG), the premalignant lesion for gastric cancer.

This retrospective cross-sectional study enrolled 12,353 participants who underwent endoscopy during health check-ups between January 2015 and December 2023. Gastric mucosal atrophy was graded according to the Kimura-Takemoto classification. To minimize confounding, propensity score matching was performed using age, sex, smoking status, alcohol consumption, and H. pylori IgG serostatus. Additional analyses were restricted to participants without a history of H. pylori eradication.

Among participants without prior H. pylori eradication, MetS was significantly associated with closed-type gastric atrophy (C2-C3) (OR 1.153, 95% CI 1.006-1.321, P = 0.041) after propensity score matching. Among the individual MetS components, abdominal obesity, hypertriglyceridemia, low HDL cholesterol, and elevated blood pressure were significantly associated with closed-type atrophy, whereas elevated fasting glucose was not. Similar findings were observed across alternative definitions of gastric atrophy (C2-O3), whereas no significant association was observed for open-type atrophy (O1-O3).

MetS and several of its components were associated with closed-type gastric atrophy (C2-C3), particularly among individuals without prior H. pylori eradication. These findings suggest that metabolic dysfunction may be associated with moderate atrophic gastric changes and support a potential role of metabolic health in gastric mucosal integrity beyond established H. pylori-related risk factors.