Is There a Relationship Between Helicobacter pylori Infection and Anthropometric Status?

Abstract

Background: Helicobacter pylori infection, overweight, and obesity are global health concerns. This bacterium is involved in the pathophysiology of chronic gastritis and gastric cancer. Additionally, overweight and obesity, associated with unhealthy eating habits and sedentary lifestyles, cause alterations in the gut microbiota that facilitate gastric colonization by Helicobacter pylori. Moreover, individuals with obesity tend to consume low-quality foods due to episodes of anxiety and exhibit elevated insulin levels, which may promote the development of gastric neoplasms. Studies conducted in Latin America have found that over 50% of participants are infected with Helicobacter pylori, a situation similar to that reported in Ecuador, where the prevalence of overweight and obesity in individuals aged 19 to 59 years reached 64.58% in 2018. Both health issues are influenced by the high consumption of processed foods or those prepared under inadequate hygiene conditions. Methods: In this context, this research aimed to correlate the body composition of university students with the prevalence of Helicobacter pylori. An observational, cross-sectional, and descriptive study was conducted with 57 Nursing, Medicine, and Psychology students from Universidad Indoamérica, Ambato campus, during 2024. Fecal samples were analyzed to detect the presence of the bacterium, and anthropometric measurements were taken to establish a possible relationship between these parameters. Results: Of the 57 students who participated, 54.39% tested positive for Helicobacter pylori. However, the presence of the bacteria did not show any relationship with body composition parameters such as fat mass, lean mass, BMI, weight, height, or age. Conclusions: The study found no evidence of a connection between Helicobacter pylori infection and anthropometric parameters in this university population. However, the high incidence of infections highlights the importance of promoting the consumption of safe food and ensuring timely diagnosis and treatment.

1. Introduction

It is estimated that approximately 50% of the global population is infected with Helicobacter pylori, reaching up to 80% in developing countries, affecting people of all ages, ethnicities, and genders. University students are at high risk due to poor dietary habits, which may lead to acute and chronic gastritis, reducing academic performance [1]. Initially asymptomatic, this infection can cause irreversible gastric mucosa changes, increasing the prevalence of chronic gastritis, peptic ulcers [2], and premalignant lesions that may develop into gastric cancer, a leading cause of cancer-related deaths worldwide [1,3,4,5]. Ecuador also presents a high prevalence of Helicobacter pylori infection, as evidenced by studies in various regions [6,7,8]. Moreover, cancer prevalence in Ecuador has increased, including colorectal cancer (CRC), which has been linked to Helicobacter pylori through its association with polyps and colonic neoplasms [9]. Obesity, a global public health issue, is considered a chronic inflammatory disease [10]. In recent years, the obesity pandemic and metabolic syndrome (MS) have become a predominant issue within the population [11]. The rising prevalence of obesity and metabolic syndrome (MS) is concerning, affecting approximately two billion people worldwide, or 30% of the global population [12]. In Ecuador, 64.58% of individuals aged 19–59 were overweight or obese in 2018 [13]. Unhealthy dietary habits, particularly processed food consumption, are major contributing factors [13] and may also influence Helicobacter pylori infection risk due to poor food hygiene [14,15].

In a recent study, Grajeda Díaz et al. [16] found that lifestyle is the strongest predictor of Helicobacter pylori presence, with individuals with a BMI > 24.9 being nearly three times more likely to be infected. Other studies indicate that Helicobacter pylori infection increases insulin resistance and may contribute to obesity [16,17]. Hormonal and physiological changes have also been proposed as links between Helicobacter pylori positivity and obesity [16].

According to the U.S. National Cancer Institute, Helicobacter pylori infection is a primary cause of peptic ulcers, chronic gastritis, and gastric cancer [18].

In Ecuador, the high incidence of Helicobacter pylori, linked to unfavorable socioeconomic conditions, highlights the urgency of mass screening and health education initiatives [6]. Raising awareness about early detection and treatment is crucial to reducing the burden of Helicobacter pylori-related diseases. Research in this field is essential to developing effective interventions for gastrointestinal health [1,4,19].

The Ecuadorian Society of Gastroenterology reports that 70% of Ecuadorians carry Helicobacter pylori, a notably high prevalence [20]. Various studies confirm a strong association between Helicobacter pylori and chronic gastritis [15,21], with follow-ups suggesting risks for MALT-type lymphomas [15]. High gastric cancer rates in Latin America, including Colombia, have been linked to genetic studies of Helicobacter pylori and its role in premalignant lesions [4].

Although the link between Helicobacter pylori, chronic gastritis, and gastric cancer is well-documented, the role of nutrition in these conditions must also be considered. Aimasso [1] highlighted the pathogen’s impact on nutrient malabsorption, including iron, cobalamin, and vitamins C and E, affecting nutritional status. A 2022 review confirmed gut microbiota differences between gastric cancer patients and healthy individuals, influenced by dietary habits [22]. Early detection through gut microbiota analysis and the potential role of probiotics and antibiotics in gastric cancer prevention were also noted [22]. A study at the Ecuadorian Institute of Digestive Diseases linked Helicobacter pylori to gastric pathologies, such as antral ulcers and erythematous pangastritis, but found no association with demographic factors like age or sex, similarly to what was reported by Korotkaya et al. [23].

Given these considerations, this study aims to correlate body composition and Helicobacter pylori infection.

2. Materials and Methods

An observational, cross-sectional, descriptive study was carried out that included first-, second-, and third-level students on the nursing, medicine, and psychology careers of the Indoamerica Technological University, Ecuador at Ambato city campus, in the period from the 1 July to 15 November 2024.

2.1. Population

The patients were second- and third-level students on the nursing, medicine and psychology careers at the Indoamérica Technological University, Ambato campus, Manuela Saenz campus; in the period from the 1 July to 15 November 2024. A sample was taken according to the following inclusion and exclusion criteria.

Inclusion criteria: students enrolled in the first, second and third semesters of the nursing, medicine, and psychology careers at the FACS-BH of the Indoamerica Technological University, Ambato campus, Manuela Saenz campus, with an age equal to or greater than 18 years and less than or equal to 28 years, of all ethnicities, as well as those who signed the informed consent.

Exclusion criteria: students previously diagnosed with Helicobacter pylori, those who dropped out of the careers in the selected period, students who decided to revoke their consent during the course of the research, those who took drag courses, students at other levels of these careers.

2.2. Data Collection

Informed consent was requested from the students who participated in the research.

Previously validated surveys were carried out on the students, guided by the researchers, in which data were obtained, such as age, sex, place of residence (urban or rural), personal pathological history, symptoms of upper digestive disorders (acidity, epigastralgia, abdominal distension, slow digestion, regurgitation) (https://www.tuasaude.com/es/como-identificar-los-sintomas-de-la-gastritis/, accessed on 15 September 2024), risk factors for gastritis, and eating habits.

A sample of feces was taken from the students in the week following the exams of the first hemicycle. That early in the morning, they were summoned to collect the sample and also a bioimpedance (in body) was performed without shoes, with light clothing, and without accessories or metal devices around their bodies.

The data obtained from the survey and the results of the Helicobacter pylori tests in feces were triangulated and collected in a data collection form prepared for research purposes by the author (Supplementary Materials).

Statistical and inferential methods (using SPSS 21 software) were used for the analysis of the data and results, which were presented in texts, tables, and statistical figures.

2.3. Materials

The materials used were sample collection bottle, Helicobacter pylori antigen detection test kits (Advin Biotech, Helicobacter pylori Antigen Rapid Test Cassette), handling gloves, masks, disposable gowns, liquid soap, alcohol, In Body 120 scale, paper towels, common and biological waste bins, pens, sheets for printing informed consent and data collection, printer, laptop, folders, and filing cabinet.

2.4. Procedings

2.4.1. Fecal Samples

Fecal Sample Collection:

A small amount of stool is collected from the patient using a collector or applicator provided in the kit. The sample must be fresh or preserved according to the manufacturer’s instructions if necessary.

Sample Preparation:

The sample is mixed with a buffer or diluent included in the kit. This step helps dissolve the antigens and facilitates their detection.

Application to the Test Device:

A specific amount of the prepared mixture is applied to the sample port of the rapid test device.

Reaction Development:

The device contains a reactive strip with monoclonal or polyclonal antibodies specific to Helicobacter pylori antigens. If the antigens are present in the sample, they will bind to the antibodies labeled with a visual indicator (commonly colloidal gold particles or dyes).

Result Interpretation:

Visible bands appear in a reading window:

• Test band (T): Indicates the presence of Helicobacter pylori antigens if formed.
• Control band (C): Confirms that the test was performed correctly.

The result can be positive, negative, or invalid, depending on the band formation.

2.4.2. Bioimpedance

Test Preparation:

• Ensure the scale is calibrated and set to zero; it should be clean and ready for use.
• Enter the patient’s data into the InBody 120 software.
• Request the patient to remove shoes, socks, piercings below the neck, necklaces, rings, bracelets, and any heavy or metallic items.

Test Procedure:

• The patient is asked to step onto the scale and position their feet on the metallic area in an anatomical stance.
• When prompted by the scale, the patient is handed the device to hold, ensuring that their thumbs make contact with the metallic part while maintaining an anatomical stance. The patient remains in this position until the machine beeps, signaling that the test is complete and they may step off the device.

Data Collection:

• The software displays measurements such as fat, muscle, water, bone, proteins, and other parameters. These results are automatically stored in a database.

2.5. Ethical Approval

This research has the approval of an ethics committee for its conduct, under code UA-2021-03-11 of the University of Alicante.

2.6. Statistical Analysis

For the statistical analysis, data were collected in a database using SPSS 21^® for Windows statistical software. The characteristics of the subjects were described using descriptive statistical analysis techniques. To perform the quantitative analysis, variables were summarized as the median an de standard deviation, most of the variables have a normal distribution of data [using, e.g., Kolmogorov–Smirnov test]. All the results from inferential tests when p < 0.05 were considered statistically significant.

3. Results

3.1. Population

The research was conducted with 57 participants enrolled in the early semesters of health-related programs at Indoamérica University in Ambato, Ecuador. Of the students, 68.4% were female and 31.6% were male, with an average age of 20.38 years and a standard deviation of ±2.45 years.

3.2. Body Composition

On the other hand, as shown in

Table 1. Subjects’ general description of anthropometric parameters.

	Mean	Standard Deviation
Height (centimeters)	159.82	±9.6
Weight (kilograms)	64.22	±17.35
IMC (kilograms/square meter)	24.9	±5.20

, the average body mass index (BMI) of the students was 24.9 kg/m², which is considered high for a young population, with a standard deviation of ±5.20. The data of the proteins, Body Fat Mass and Skeletal Muscle Mass is shown at

Table 2. Subjects body composition summary of in body bioimpedance.

	Mean	Standard Deviation
Protein	8.67	± 2.26
Minerals	3.01	± 0.72
Body Fat Mass (BFM, kilograms)	20.53	±9.85
Skeletal Muscle Mass (SMM, kilograms)	24.13	±6.81
Percent Body Fat (PBF; percentage)	31.19	±8.91
Target Weight	56.73	±10.40
Waist–Hip Ratio (WHR, centimeters)	0.90	±0.057

All the data for body composition was obtained with an in body bioimpedance.

.

Helicobacter pylori comparison:

Of the 57 students who participated, 54.39% tested positive for Helicobacter pylori, as shown in Figure 1. However, the presence of the bacteria did not show any relationship with body composition parameters such as fat mass, lean mass, BMI, weight, height, or age, as detailed in

Table 3. Relation between body composition parameters and the presence of Helicobacter pylori-positive antigen in stool.

	P (Significance) Spearman Test
Age	0.4
Sex	0.068
Skeletal Muscle Mass	1.00
Body Mass Index	0.609
Percentage Body Fat	0.773
Waist–Hip Ratio	0.393

There is no apparent relationship.

.

However, as shown in

Table 4. Relation between the gender and the presence of Helicobacter pylori-positive antigens in stool.

	Helicobacter pylori	Gender
Chi-Square	3.667	2.455
Significance	0.055	0.12

, although the results indicate no statistically significant relationship between gender and the presence of Helicobacter pylori-positive antigens in stools, it is worth noting that the percentage of male students with Helicobacter pylori-positive antigens in stools (72.22%) is higher than that of female participants (54.55%), despite male participation being only one-third of the female group, as shown in Figure 2.

4. Discussion

The results of this study provide insight into the relationship between Helicobacter pylori infection and anthropometric status in young university students. Despite observing a high prevalence of Helicobacter pylori (54.55%), no significant association was found between its presence and body mass index (BMI), fat mass, lean mass, or waist-to-hip ratio. These findings align with a 2018 study in Lebanon, which also reported no relationship between Helicobacter pylori infection and dietary habits or weight [24]. However, other studies suggest a positive correlation between Helicobacter pylori and obesity [16,25].

In contrast, a systematic review found that Helicobacter pylori-positive patients had a higher likelihood of obesity, and obese individuals had an increased risk of infection [25]. Additionally, research on eating disorders suggests a low association between Helicobacter pylori infection and disordered eating behaviors [26]. These discrepancies may result from differences in sample size, methodology, or population characteristics such as age, lifestyle, and dietary habits.

Regarding sex, although no statistical significance was found, a higher percentage of women (61%) tested positive compared to men (39%), warranting further investigation into potential gender-based susceptibility, possibly mediated by hormonal factors.

Our findings align with studies in developing countries, where factors such as food hygiene, socioeconomic status, fast food consumption, and sedentary lifestyles contribute to Helicobacter pylori prevalence. Aguilar’s study in Santa Rosa, Peru, supports global evidence that Helicobacter pylori infection often begins early in life and is highly prevalent worldwide, including in Ecuador [27]. Calderón et al. [28] found a prevalence of 21.1% in Cajamarca, Peru, with higher rates in men and children using latrines. Similarly, studies in Santa Elena and Carchi, Ecuador, reported a prevalence of 66.7%, with regional variations [20].

Internationally, studies have examined the relationship between Helicobacter pylori infection, obesity, and inflammation. A U.S. study on low-income communities found that while Helicobacter pylori infection correlated with lower adiposity measures, it was linked to elevated C-reactive protein (CRP) levels, indicating systemic inflammation [29]. Additionally, research suggests that obesity may influence gastric colonization due to microbiota changes and chronic inflammation, although our study does not support this hypothesis, likely due to the homogeneity of the sample [2].

Other studies have explored the association between Helicobacter pylori and type 2 diabetes mellitus (T2DM). Evidence suggests links between Helicobacter pylori IgG antibodies, chronic gastritis, and increased risk of T2DM, obesity, and blood glucose dysregulation [30].

A European study found increased BMI after Helicobacter pylori eradication in both adults and children, suggesting a potential role in weight regulation [31]. Similarly, a retrospective cohort of 305 severely obese patients undergoing Roux-en-Y gastric bypass (RYGB) surgery found no significant difference in weight loss outcomes between Helicobacter pylori-negative and eradicated patients over five years [32]. These findings align with the Study of Environmental Enteropathy and Malnutrition (SEEM) in Pakistan, which seeks biomarkers for malnutrition linked to enteric infections [33].

Furthermore, research on gut microbiota suggests a complex relationship between diet, BMI, and Helicobacter pylori. In India, certain bacterial strains, such as Faecalibacterium and Ruminococcus, may help control Helicobacter pylori in overweight vegetarians, while Akkermansia muciniphila may play a protective role in non-vegetarians [34]. Additionally, a Chinese study found that Helicobacter pylori infection increased the risk of low skeletal muscle mass in women over 40, highlighting the need for early eradication in this population [35].

Although our study did not establish a direct link between Helicobacter pylori and anthropometric parameters, the long-term effects of chronic infection on metabolism and body composition require further research. Future studies should examine larger, more diverse populations to clarify these relationships.

5. Conclusions

The study found no evidence of a connection between Helicobacter pylori infection and anthropometric parameters in this young university population. However, we should not overlook the high incidence of positive infections, which indicates the need to incorporate strategies that encourage the consumption of safe foods, as well as timely diagnosis and treatment. This is crucial, as the long-term impact of the presence of this bacterium in the gastrointestinal tract is associated with a higher risk of developing gastric malignancies. Additionally, it would be important to conduct another type of study that associates sociodemographic factors, lifestyle, and personal and family medical history, which would allow for a more comprehensive approach.