Relationship between Helicobacter pylori infection and risk of metabolic dysfunction‐associated steatotic liver disease: An updated meta‐analysis

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Abstract Background Recent observational studies examining the association between Helicobacter pylori infection and the risk of metabolic dysfunction‐associated steatotic liver disease (MASLD) have reported conflicting results. We performed a meta‐analysis to quantify the magnitude of the association between H. pylori infection and the risk of MASLD. Methods We systematically searched three large electronic databases to identify eligible observational studies (published up to 30 November 2023) in which liver biopsy, imaging methods or blood‐based biomarkers/scores were used for diagnosing MASLD. Data from selected studies were extracted, and meta‐analysis was performed using common and random‐effects modelling. Statistical heterogeneity among published studies, subgroup analyses, meta‐regression analyses and publication bias were assessed. Results A total of 28 observational studies (24 cross‐sectional and 4 longitudinal studies) were identified, including 231 291 middle‐aged individuals of predominantly Asian ethnicity (~95%). Meta‐analysis of cross‐sectional studies showed that H. pylori infection was significantly associated with a small increase in the risk of prevalent MASLD (n = 24 studies; random‐effects odds ratio 1.11, 95% CI 1.05–1.18; I2 = 63%). Meta‐analysis of data from longitudinal studies showed that H. pylori infection was significantly associated with an increased risk of developing incident MASLD over a mean 5‐year follow‐up (n = 4 studies; random‐effects odds ratio 1.20, 95%CI 1.08–1.33; I2 = 44%). Sensitivity analyses did not modify these results. The funnel plot did not reveal any significant publication bias. Conclusions H. pylori infection is associated with a mildly increased risk of prevalent and incident MASLD. Further well‐designed prospective and mechanistic studies are required to better decipher the complex link between H. pylori infection and the risk of MASLD.

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