Association of metabolic variants with Helicobacter pylori infection risk: A retrospective cross-sectional study

BackgroundHelicobacter pylori infection is widespread worldwide and is associated with gastric cancer, posing global public health challenges. Previous studies have linked dyslipidemia with Helicobacter pylori infection but have generally described overall lipid changes, with limited lipid-profile analysis.ObjectiveTo examine the associations between calculated lipid ratios and Helicobacter pylori infection among individuals without diabetes.MethodsParticipants without diabetes who underwent the ¹³C-urea breath test were included. We calculated lipid ratios (triglyceride/total cholesterol, triglyceride/low-density lipoprotein cholesterol (LDL-C), triglyceride/high-density lipoprotein cholesterol (HDL-C), LDL-C/HDL-C, non-HDL-C/HDL-C, fasting plasma glucose/HDL-C, uric acid/HDL-C, and higher glycosylated hemoglobin/HDL-C). Analyses included univariate and multivariate binary logistic regression, receiver operating characteristic analysis (area under the curve), restricted cubic spline modeling, and threshold analysis. The stability of the nonlinear relationship was further evaluated through sensitivity analyses using alternative knot configurations.ResultsA total of 400 participants without diabetes (75 with H. pylori infection and 325 without H. pylori infection) were analyzed. Compared with participants without H. pylori infection, patients with H. pylori infection showed significant differences in neutrophil count, fasting plasma glucose, uric acid, total cholesterol, triglyceride, HDL-C, LDL-C, and non-HDL-C (p < 0.05). LDL-C/HDL-C was an independent risk factor for H. pylori infection (p = 0.007). Receiver operating characteristic analysis yielded an area under the curve of 0.713, a Youden index of 0.356, and an optimal cutoff value of 2.24 (sensitivity, 78.7%; specificity, 56.9%). In the primary three-knot model selected by Akaike information criterion, restricted cubic splines analysis indicated a significant, nonlinear association between LDL-C/HDL-C- Helicobacter pylori (p overall < 0.001; p nonlinear ≈ 0.02). This nonlinear trend and the overall inflection pattern remained robust in sensitivity analyses (p overall < 0.001), remaining statistically significant with five knots (p nonlinear = 0.041), although slightly attenuated with four knots (p nonlinear = 0.068). Piecewise logistic regression identified an inflection point at approximately1.94 (likelihood ratio p = 0.006). For LDL-C/HDL-C < 1.94, the risk of infection increased sharply with each unit increase (odds ratio = 68.00, 95% confidence interval: 1.83-2521.00, p = 0.022).ConclusionLDL-C/HDL-C is an independent, nonlinear predictor of Helicobacter pylori infection in individuals without diabetes and may serve as a practical biomarker for risk stratification. Implications include lipid-centered prevention through dietary and lifestyle interventions. Larger prospective studies are needed to validate causality and assess applicability across metabolic phenotypes.