|Year : 2020 | Volume
| Issue : 1 | Page : 41-44
Association between metabolic syndrome and Helicobacter pylori infection: A myth or a fact? A cross-sectional study
Varun J Shetty1, HL Kishan Prasad2, Aashish Sharma Konamme3, K Jayapraskash Shetty4, Ganaraj Kulamarva5
1 IIIrd MBBS Student, Department of Pathology, KS Hegde Medical Academy of Nitte (Deemed to be University), Mangaluru, Karnataka, India
2 Additional Professor of Pathology, Department of Pathology, KS Hegde Medical Academy of Nitte (Deemed to be University), Mangaluru, Karnataka, India
3 Assistant Professor of Pathology, Srinivas Institute of Medical Sciences, Mangaluru, Karnataka, India
4 Professor and Head, Department of Pathology, KS Hegde Medical Academy of Nitte (Deemed to be University), Mangaluru, Karnataka, India
5 Associate Professor of Medical Gastroenterology, KS Hegde Medical Academy of Nitte (Deemed to be University), Mangaluru, Karnataka, India
|Date of Submission||04-Nov-2019|
|Date of Acceptance||18-Nov-2019|
|Date of Web Publication||17-Mar-2020|
Dr. H L Kishan Prasad
KS Hegde Medical Academy of Nitte (Deemed to be University), Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Aim: To determine the association between Helicobacter pylori and metabolic syndrome. Methods: This study comprised 31 study subjects whose biopsies were positive for H. pylori. Fasting plasma glucose (FPG), body mass index, serum triglycerides, serum high-density lipoprotein (HDL), and blood pressure were estimated in this group. Abnormalities in at least three of the five parameters were considered to be metabolic syndrome. Results: The results showed a significant association between H. pylori and metabolic syndrome, based on P = 0.007 (<0.05) in the Chi-square test. There was also an insignificant correlation between sex and metabolic syndrome (P = 0.576). A large percentage of the study group had high FPG (67.74%), low serum HDL (77.42%), and hypertension (87.10%). 78.2% of the study group had metabolic syndrome. Conclusion: The present study suggests that H. pylori gastritis is significantly associated with metabolic syndrome. It is recommended to do further research using a larger sample size to explore the relationship between Metabolic syndrome and H. pylori infection. The H. pylori eradication can be used as a tool in the prevention and treatment of metabolic syndrome.
Keywords: Body mass index, high-density lipoprotein, Helicobacter pylori, metabolic syndrome
|How to cite this article:|
Shetty VJ, Kishan Prasad H L, Konamme AS, Shetty K J, Kulamarva G. Association between metabolic syndrome and Helicobacter pylori infection: A myth or a fact? A cross-sectional study. Biomed Biotechnol Res J 2020;4:41-4
|How to cite this URL:|
Shetty VJ, Kishan Prasad H L, Konamme AS, Shetty K J, Kulamarva G. Association between metabolic syndrome and Helicobacter pylori infection: A myth or a fact? A cross-sectional study. Biomed Biotechnol Res J [serial online] 2020 [cited 2022 Aug 8];4:41-4. Available from: https://www.bmbtrj.org/text.asp?2020/4/1/41/280860
| Introduction|| |
Helicobacter pylori is a Gram-negative, microaerophilic bacillus, usually found in the stomach. More than 50% of the world's population have H. pylori in their upper gastrointestinal tract. The recent literature shows that 80% of individuals infected with H. pylori are asymptomatic. The rest of the 20% are symptomatic, showing symptoms of either acute gastritis such as nausea and abdominal pain or those of chronic gastritis such as abdominal pain, nausea, bloating, belching, vomiting, and melena. H. pylori is known to be strongly associated with peptic ulcers, gastric carcinoma, and lymphoma. In tropical and semitropical countries, H. pylori infection is associated with duodenal ulcer being the predominant manifestation. The disease is more common in developing countries in comparison to the developed Western nations. India is a prototypical developing country as far as H. pylori infection is concerned, with an estimated population of >20 million Indians suffering from peptic ulcer disease.
Metabolic syndrome is a clustering of at least three of the five following medical conditions, namely, abdominal obesity, high blood pressure, high blood sugar, elevated serum triglycerides, and low high-density lipoprotein (HDL) levels. Metabolic syndrome is associated with the risk of developing type 2 diabetes mellitus and cardiovascular disease., Age-standardized prevalence rates of the metabolic syndrome were 33.5% overall, 24.9% in males, and 42.3% in females. Old age, female gender, obesity, improper diet, hypercholesterolemia, and middle-to-high socioeconomic status significantly contributed to risk of metabolic syndrome. It is a significant public health problem in developing and developed countries. There is a lack of research on the possible association between H. pylori infection and metabolic syndrome in developing countries like India. The purpose of our study is to determine the association between metabolic syndrome and H. pylori infection. If an association is established between the two, suitable measures can be taken to prevent the disease from progressing, thus reducing the morbidity and mortality from peptic ulcer, gastric carcinoma, and the complications of metabolic syndrome.
Aims and objectives
The objective of the study was to determine the association between metabolic syndrome and H. pylori infection in India.
| Methods|| |
It was a cross-sectional study done with 31 patients who presented with symptoms of gastritis and with upper gastrointestinal tract biopsy sample positive for H. pylori infection. Institutional ethics committee permission was obtained for the study. Written consent was taken from the study participants.
Patients whose biopsies were positive for H. Pylori infection.
Patients whose biopsies were negative for H. Pylori infection.
Collection of biopsy sample
The study subjects were advised to maintain nil per oral status for 6 h. Xylocaine anesthesia was administered, and the biopsy samples were collected according to the modified Sydney Protocol, under the upper gastrointestinal scopy guidance. Samples were subjected to routine histopathological processing. The H. pylori infection was confirmed by hematoxylin and eosin stain.
Collection of blood sample
The venepuncture was performed under strict aseptic precautions, and 2 ml each of blood was collected in a fluoride spray-coated collection tube and a plain collection tube with clot activator from each subject following an overnight fast. Blood collected in fluoride spray-coated tube was used for the estimation of fasting plasma glucose (FPG); the serum separated from the blood in the plain tube was used for the estimation of serum lipid profile. FPG was estimated by GOD-POD method. Lipid profile was estimated using Cobas C311 autoanalyzer from Roche Hitachi, using kits from the same company. The serum triglycerides were estimated by GPO–ESPAS method. The serum HDL was analyzed by IC ACID method. To consider the glucose level for metabolic syndrome, it should ≥ 100 mg/dL. Body mass index (BMI) was calculated using the formula: weight (kg)/(height [m])2. Systolic and diastolic blood pressures were measured using a manual sphygmomanometer with adult cuff after the participant was seated and quiet for a minimum of 10 min.
Study subjects with at least three of the five criteria [Figure 1] were considered to have metabolic syndrome. Based on these parameters, the association between metabolic syndrome and H. pylori infection was assessed.
The raw data were compiled. SPSS v20 software(IBM Corp., IBM SPSS statistics for Windows, Armonk, New York )was used for the analysis of the data. Descriptive statistics such as median and interquartile range of the collected data was computed. Fisher's exact test was done to analyse the association between gender and metabolic syndrome. Chi-square test was done to explain the association between H. pylori and metabolic syndrome.
| Results|| |
This study involved the estimation of FPG, BMI, serum triglycerides, serum HDL, and blood pressure in patients whose biopsies were positive for H. pylori infection. These are the observed values in the study population as shown in [Table 1].
|Table 1: Observed values of fasting plasma glucose, triglycerides, high-density lipoprotein, systolic blood pressure, diastolic blood pressure, and body mass index among the study subjects|
Click here to view
A total of 31 patients were enrolled in the study. Among them, 9 (29.0%) were female, and 22 (71.0%) were male.
Twenty-three (74.2%) out of the 31 study subjects studied were found to have metabolic syndrome. Metabolic syndrome was absent in eight patients comprising 25.8%.
To determine the association between the presence of metabolic syndrome and sex of the population, Fisher's exact test was carried out. The test gave P = 0.576 (>0.05), suggesting an insignificant correlation between metabolic syndrome and gender, as shown in [Table 2].
To determine the association between H. pylori and metabolic syndrome, the Chi-square test was done. The test gave P = 0.007 (<0.05), suggesting a statistically significant positive correlation between H. pylori and metabolic syndrome, as shown in [Table 3].
|Table 3: With Chi-square test to determine its association with Helicobacter pylori|
Click here to view
| Discussion|| |
Metabolic syndrome is a clustering of at least three of the five following medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low HDL levels.,,, Our study included 31 patients whose biopsies were positive for H. pylori infection. FPG, BMI, serum triglycerides, serum HDL, and blood pressure were estimated in this group.
In our study group, 21 (67.74%) patients had elevated FPG. In a study conducted by Toshiaki Gunji et al., H. pylori infection was found to have significantly and independently contributed to promoting insulin resistance in a large asymptomatic population. H. pylori infection impairs secretion balance of proinflammatory cytokines and CRP, angiotensinogen, free fatty acids, and leptin hormone, and thus, reactive oxygen radicals begin to accumulate. Subclinical chronic inflammation occurs via impaired cytokine balance and stimulated macrophages. There are explanations that this leads to unresponsiveness to insulin in the peripheral tissue.
In our study group, 12 (35.48%) patients had elevated serum triglyceride levels. There were also 24 (77.42%) patients, having decreased serum HDL levels. Satoh et al. conducted a study on the effect of H. pylori infection on lipid profile in Japanese subjects where it was found that adjusted mean values of low-density lipoprotein cholesterol and HDL cholesterol in men were significantly higher and lower in H. pylori-seropositive than negative subjects, respectively, whereas these associations were not significant in female subjects. However, in our study, no significant difference was found in the HDL between males and females in the study group. Takashima et al. demonstrated that H. pylori causes a low HDL level.
In our study group, 27 (87.10%) patients were hypertensive. Lip et al. conducted a study on the association of H. pylori infection with coronary heart disease, which showed the association between H. pylori infection and hypertension.
In our study group, 8 (25.81%) patients were overweight. Obesity, a component of metabolic syndrome, is one of the significant health problems worldwide. Perdichizzi et al. determined higher BMI values and waist circumference measurements in H. pylori-positive patients.
In our study group, there were 23 (78.2%) patients in whom metabolic syndrome was present. In a study conducted on the relationship between H. pylori infection and metabolic syndrome in the Turkish population where metabolic syndrome was present in 78.8% of the H. pylori positive patients. Hence, our findings are consistent with those of previous research.
Therefore, further evaluation of the role of H. pylori in causing metabolic syndrome is required to prevent the complications arising as a result of developing metabolic syndrome.
| Conclusion|| |
The present study suggests that H. pylori infection is significantly associated with metabolic syndrome. This finding will help explore the pathogenesis of the metabolic syndrome. It is necessary to do further research with extensive group studies to probe the relationship between H. pylori infection and metabolic syndrome. We believe that H. pylori eradication has the potential to be used in the prevention and treatment of the metabolic syndrome. This will also reduce the complications arising from metabolic syndrome. We recommend that all patients having H. pylori infection undergo screening for metabolic syndrome or vice versa.
We acknowledge the contributions of the Department of Medical Gastroenterology, Department of Pathology, Department of Biochemistry and the Statistician.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Amieva M, Peek RM Jr. Pathobiology of Helicobacter pylori
-induced gastric cancer. Gastroenterology 2016;150:64-78.
Blaser MJ. Who are we? Indigenous microbes and the ecology of human diseases. EMBO Rep 2006;7:956-60.
Thirumurthi S, Graham DY. Helicobacter pylori
infection in India from a Western perspective. Indian J Med Res 2012;136:549-62.
] [Full text]
Henry R, Connor BA. Helicobacter pylori
. Yellow Book. CDC Travelers 'Health. Ch. 3. Atlanta, Geogia: Oxford university press; 2016. p. 187.
Kaur J. A comprehensive review of metabolic syndrome. Cardiol Res Pract 2014;2014:943162. doi: 10.1155/2014/943162.
Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech 2009;2:231-7.
Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India. J Cardiovasc Dis Res 2012;3:204-11. [Full text]
International Diabetes Federation. The IDF Consensus Worldwide Definition of the Metabolic Syndrome. IDF communications; 2006:2-24.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al
. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in Adults: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension 2018;71:1269-324.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
Gunji T, Matsuhashi N, Sato H, Fujibayashi K, Okumura M, Sasabe N, et al. Helicobacter pylori
infection significantly increases insulin resistance in the asymptomatic Japanese population. Helicobacter 2009;14:144-50.
Satoh H, Saijo Y, Yoshioka E, Tsutsui H. Helicobacter pylori
infection is a significant risk for modified lipid profile in Japanese male subjects. J Atheroscler Thromb 2010;17:1041-8.
Takashima T, Adachi K, Kawamura A, Yuki M, Fujishiro H, Rumi MA, et al.
Cardiovascular risk factors in subjects with Helicobacter pylori
infection. Helicobacter 2002;7:86-90.
Lip GH, Wise R, Beevers G. Association of Helicobacter pylori
infection with coronary heart disease. Study shows association between H pylori
infection and hypertension. BMJ 1996;312:250-1.
Perdichizzi G, Bottari M, Pallio S, Fera MT, Carbone M, Barresi G. Gastric infection by Helicobacter pylori
and antral gastritis in hyperglycemic obese and in diabetic subjects. New Microbiol 1996;19:149-54.
[Table 1], [Table 2], [Table 3]