Effect of Helicobacter Pylori Infection on Glucose Metabolism, Lipid Metabolism and Inflammatory Cytokines in Nonalcoholic Fatty Liver Disease Patients

There is a direct association between H. pylori infection and insulin resistance and dyslipidemia, both presently recognized as factors contributing to the development of MASLD. Several studies revealed a positive correlation between H. pylori infection and MASLD, similar to this study, while some clinical studies negate this conclusion.3 This may be due to variability in H. pylori strains, inconsistent H. pylori diagnostic methods, updated MASLD diagnostic criteria, and regional differences in race, genetics, lifestyle, and dietary habits. A possible mechanism of interaction between H. pylori infection and MASLD involves fetuin-A or alpha 2-HS glycoprotein (AHSG). Higher serum fetuin-A levels in H. pylori-positive patients have been reported to correlate with impaired insulin sensitivity and glucose tolerance.5 Fetuin-A also acts as an endogenous adaptor protein for free fatty acid-mediated activation of TLR4 in mice. This might reflect the presence of a broad panel of inflammatory mediators (c-reactive protein, TNF-?, IL-6, IL-1?) in patients suffering from H. pylori infection.6 Future research should employ large-scale and multi-center randomized controlled trials to objectively and effectively assess the influence of H. pylori infection in MASLD patients.