Could Helicobacter pylori Infection Impair Glucose Tolerance in Obese Non-diabetic Subjects?

Helicobacter pylori (HP) is a common gastrointestinal infectious agent with half of the world’s population being infected. In addition to its well-demonstrated role in gastroduodenal diseases, it may have a potential role in several extra-intestinal pathologies including metabolic, hematological, cardiovascular, neurological, autoimmune and skin diseases. There is a controversy about the prevalence of HP in obese patients and its association with metabolic alterations in those patients. This study aimed to detect the relation of HP infection to insulin resistance, glycated hemoglobin and lipid profile in obese subjects.

Subjects and Methods: This study was performed on 125 obese non diabetic subjects with BMI ≥30 kg/m2 and age ranged from 22 to 52 years. They were 90 females and 35 males. They were divided according to seropositivity of Helicobacter pylori IgG antibody into HP positive & HP negative groups. HP positive group comprised 83 subjects (60 females and 23 males) and were further subdivided into CagA+ve (13 subjects) and CagA-ve (70 subjects). HP negative group included 42 subjects (30 females and 12 males). Blood glucose, lipid profile, HbA1C, insulin, H. pylori IgG and Cag A IgG antibodies were assayed. Both HOMA-IR and HOMA-B were calculated from fasting blood glucose and fasting insulin levels.

Results: A statistical significant increase in HOMA-IR, cholesterol, triglycerides, HDL-C and HbA1c was observed in HP positive group compared to HP negative group. There was a significant positive correlation between seropositivity to HP and both of HOMA-IR & elevated HbA1c. Among HP +ve subjects, both HOMA-IR and HbA1c were significantly elevated in anti-Cag A IgG positive than anti-Cag A IgG negative obese subjects. Multivariate logistic regression analysis showed that HP positive subjects were 7.189 & 19.2 times more susceptible to insulin resistance and increased HbA1c respectively than HP negative subjects. Also anti-Cag A IgG +ve persons were more susceptible to insulin resistance by 8.8 times more than negative subjects.

Conclusions: H. pylori infection is associated with dyslipidemia, IR and elevated HbA1c in obese subjects. Whether these metabolic alterations are due to HP infection or just an association needs further studies to determine the effect of HP eradications on these metabolic alterations.