Insulin resistance in children with Helicobacter pylori infection

Effects of Helicobacter pylori eradication on insulin resistance and metabolic parameters: a systematic review and meta-analysis

INTRODUCTION

Previous studies have shown a close relationship between Helicobacter pylori (H. pylori), insulin resistance, and altered metabolic parameters. However, the effects of H. pylori eradication on these conditions remain controversial. We carried out a systematic review and meta-analysis to evaluate the effects of H. pylori eradication on insulin resistance and metabolic parameters.

METHODS

We searched CENTRAL, MEDLINE, and EMBASE databases from their inception to July 2016. Insulin resistance (HOMA-IR), body weight (BW), BMI, waist circumference, triglycerides (TG), high-density and low-density lipoprotein-cholesterol (HDL-C and LDL-C), and fasting blood glucose (FBG) were compared between patients with and without H. pylori eradication using a random-effects model. We reported pooled mean differences (MD) and 95% confidence intervals (CI) for the change in outcomes.

RESULTS

Data from five studies showed no difference in HOMA-IR after H. pylori eradication (pooled MD=-0.52, 95% CI: -1.47 to 0.42). Eradication significantly increased BMI (MD=0.36, 95% CI: 0.11-0.60) and BW (MD=1.1, 95% CI: 0.8-1.5), but had no significant effects on TG, LDL-C, HDL-C, or FBG.

CONCLUSION

H. pylori eradication does not improve insulin resistance, TG, HDL-C, LDL-C, or FBG, but may increase BW and BMI. Further studies are needed to clarify the effect of H. pylori eradication on metabolism.

Infections: A Possible Risk Factor for Type 2 Diabetes

Diabetes mellitus is one of the biggest challenges to human health globally, with an estimated 95% of the global diabetic population having type 2 diabetes. Classical causes for type 2 diabetes, such as genetics and obesity, do not account for the high incidence of the disease. Recent data suggest that infections may precipitate insulin resistance via multiple mechanisms, such as the proinflammatory cytokine response, the acute-phase response, and the alteration of the nutrient status. Even pathogen products, such as lipopolysaccharide and peptidoglycans, can be diabetogenic. Therefore, we argue that infections that are known to contribute to insulin resistance should be considered as risk factors for type 2 diabetes.

Association between Helicobacter pylori infection and metabolic syndrome: a systematic review and meta-analysis

OBJECTIVE

To systematically review and quantify the effect of Helicobacter pylori (H. pylori) infection on the risk of metabolic syndrome (MS) and metabolic parameters in individuals with H. pylori infection.

METHODS

A systematic search of MEDLINE and EMBASE was performed. Inclusion criteria were observational studies assessing the association between H. pylori infection and MS in adult participants. We calculated the pooled effect estimate of MS with 95% confidence interval (CI) between patients infected with H. pylori and those without by using a random-effects model. The secondary outcomes were the differences between groups in homeostatic model assessment of insulin resistance (HOMA-IR), triglyceride, high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), body mass index (BMI) and systolic blood pressure (SBP).

RESULTS

Altogether 18 trials with 27 544 participants met the inclusion criteria. Six trials were included in the analysis of MS. There was a statistically significant association between H. pylori and MS with a pooled odds ratio of 1.34 (95% CI 1.17-1.53, I(2)  = 39%, Pheterogeneity < 0.01). Between the infected and non-infected groups there were significant differences in FBG, HDL-C, BMI, triglyceride, HOMA-IR and SBP (all P < 0.05).

CONCLUSION

H. pylori infection is positively associated with MS. Infection with H. pylori is also associated with higher triglyceride, FBG, BMI, HOMA-IR, SBP and lower HDL-C.

Effect of Helicobacter pylori eradication on insulin resistance among prediabetic patients: A pilot study and single-blind randomized controlled clinical trial

BACKGROUND

Type II diabetes mellitus (T2DM) is the prevalent type of diabetes in the world. Prediabetic patients are the most probable group to get diabetes. Several studies have mentioned the role of inflammation in the incidence of diabetes. The origin of inflammation can be infection such as Helicobacter pylori (HP) infection. This study was designed to explore the effect of HP eradication on insulin resistance.

MATERIALS AND METHODS

This single-blind randomized controlled clinical trial was conducted in 2014-2015. The sample size consisted of 49 individuals who were in prediabetes stage with HP infection. Patients with positive stool antigen were allocated randomly into two groups. The treatment group took medication to eradicate HP infection by the routine method of four-drug eradication. However, placebo capsules and tablets were given to the patients in the placebo group. Then fasting plasma glucose (FPG), fasting plasma insulin (FPI), and quantitative C-reactive protein (CRP) levels were measured and homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of beta-cell function (HOMA-B), Matsuda index, insulinogenic index, and disposition index were calculated.

RESULTS

Results of this study showed that FPI and HOMA-IR increased significantly (P value of FPI = 0.023 and P value of HOMA-IR = 0.019) after HP eradication in the treatment group. On the other hand, comparison of differences at the baseline and after 6 weeks in FPG (P value = 0.045), FPI (P value = 0.013), and HOMA-B (P value = 0.038) revealed significant differences between the placebo group and treatment group.

CONCLUSION

Results showed that HP eradication by a 2-week antibiotic medication did not decrease insulin resistance and even increased FPI and insulin resistance indices. So HP eradication among prediabetic patients is not recommended for the decrease of insulin resistance and postponement of the development of diabetes mellitus.

The Role of Helicobacter pylori Seropositivity in Insulin Sensitivity, Beta Cell Function, and Abnormal Glucose Tolerance

Infection, for example, Helicobacter pylori (H. pylori), has been thought to play a role in the pathogenesis of type 2 diabetes mellitus (T2DM). Our aim was to determine the role of H. pylori infection in glucose metabolism in an American cohort. We examined data from 4,136 non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican Americans (MA) aged 18 and over from the NHANES 1999-2000 cohort. We calculated the odds ratios for states of glucose tolerance based on the H. pylori status. We calculated and compared homeostatic model assessment insulin resistance (HOMA-IR) and beta cell function (HOMA-B) in subjects without diabetes based on the H. pylori status. The results were adjusted for age, body mass index (BMI), poverty index, education, alcohol consumption, tobacco use, and physical activity. The H. pylori status was not a risk factor for abnormal glucose tolerance. After adjustment for age and BMI and also adjustment for all covariates, no difference was found in either HOMA-IR or HOMA-B in all ethnic and gender groups except for a marginally significant difference in HOMA-IR in NHB females. H. pylori infection was not a risk factor for abnormal glucose tolerance, nor plays a major role in insulin resistance or beta cell dysfunction.

Serum adiponectin level in diabetic patients with and without Helicobacter pylori infection: is there any difference?

Background. Increased insulin resistance is an extragastrointestinal manifestation of Helicobacter pylori (HP) infection. HP changes the level of inflammatory markers and cytokines and changes the adipocyte function by altering the adiponectin level. Given the high prevalence of HP and diabetes in our society, we evaluated the association between HP and serum adiponectin level. In this cross-sectional study, 211 diabetic patients under treatment other than insulin were studied. These patients were divided into two groups of HP+ and HP− based on their HP IgG antibody serology and their blood adiponectin levels were measured. Data was analyzed using independent t-test, Chi-square test, and Fisher's exact test. Results. Seventy-two patients with an average age of 51.56 ± 8.34 years were HP− and 139 patients with an average age of 50.35 ± 9.01 years were HP+. The mean serum adiponectin level in HP− and HP+ groups was 4.54 ± 5.43 and 5.64 ± 3.88 ng/mL, respectively. Insulin resistance degree was significantly higher in HP+ group (HP− = 3.160 ± 3.327 versus HP+ = 4.484 ± 3.781, P = 0.013) but no significant difference was found between the mean serum adiponectin level in HP− and HP+ groups (P = 0.140). Conclusions. Although the insulin resistance degree was significantly higher in HP+ diabetic patients, no significant relationship was found between HP infection and serum levels of adiponectin.

Association between metabolic syndrome and Helicobacter pylori infection diagnosed by histologic status and serological status

GOALS

We aimed to simultaneously evaluate the association between metabolic syndrome and Helicobacter pylori (HP) infection diagnosed histologically and serologically in a large number of healthy Korean adults.

BACKGROUND

Serological positivity for HP does not necessarily indicate current infection. No study to date has compared the association between metabolic syndrome and HP infection diagnosed by histologic and serological status.

STUDY

HP status was ascertained histologically and serologically in healthy Korean adults who underwent comprehensive health screening in a private health screening center in Korea. Metabolic syndrome was defined according to the International Diabetes Federation definition. Multivariate logistic analyses were performed, after adjusting for potential confounders, including age, sex, smoking, alcohol consumption, and income level.

RESULTS

A total of 5889 subjects were included in the analysis. The metabolic syndrome was more strongly associated with histologic positivity for HP [adjusted odds ratio (aOR)=1.26; 95% confidence interval (CI), 1.08-1.48] than serologic positivity (aOR=1.12, 95% CI, 0.95-1.32), after adjusting for age, sex, smoking status, alcohol consumption, and economic status.

CONCLUSIONS

The stronger association between metabolic syndrome and histologic positivity than serological positivity suggests that the effects of HP infection on the pathogenesis of cardiometabolic outcomes may be reversible. Further prospective studies are needed.

Periodontal therapy -- an adjuvant for glycemic control

AIMS

Periodontitis is an oral infection affecting the tooth- supporting tissues. Although the prime etiology for this condition is bacterial plaque, the host immune response also has substantial contribution to the destruction of the periodontal apparatus. Periodontitis elicits a "low grade systemic inflammation". Diabetes mellitus is intricately related to the development, progression and severity of periodontitis. The literature is abundant with studies depicting this association. Periodontal therapy (PT) involves removal of bacterial component leading to the resolution of clinical signs and symptoms of disease. This review aims to create awareness amongst the medical professionals regarding the two-way relationship between diabetes and periodontitis, emphasizing on the positive effects of PT.

MATERIAL AND METHODS

Studies addressing the effects of PT on glycemic control in type 2 Diabetes (T2DM) subjects were identified using PubMed search with key search terms such as "Glycemic control", "Periodontitis", "Periodontal therapy", "Type 2 diabetes mellitus". The review has been prepared by screening PUBMED database from January 1990 to March 2012.

RESULTS

PT bears an unexplored potential and can serve as an adjuvant to the conventional treatment for diabetes.

CONCLUSION

A major conclusion of this review is that PT instituted in type 2 diabetic human subjects assists in amelioration of the inflammatory biomarker levels and glycemic status. There is a wide scope for further studies to highlight the beneficial effects of PT in diabetic subjects and the dire need for periodontal screening of these individuals for glycemic maintenance.

The association between Helicobacter pylori infection and insulin resistance: a systematic review

BACKGROUND

Helicobacter pylori infection has been associated with diverse extradigestive morbidity, including insulin resistance (IR) syndrome. The aim of this systematic review was to summarize the epidemiologic evidence concerning the association between H. pylori infection and IR quantitative indexes.

MATERIALS AND METHODS

A computerized literature search in PubMed electronic databases and Cochrane Central Register of Controlled Trials was performed.

RESULTS

Nine studies reporting data on 2120 participants were finally eligible for this systematic review. Seven of them were cross-sectional studies and two were nonrandomized, open-label, controlled trials investigating the effect of H. pylori eradication on IR. Homeostatic model of assessment insulin resistance (HOMA-IR) was used in all studies to quantify IR. There seems to be a trend toward a positive association between H. pylori infection and HOMA-IR, strengthened by regression analysis in one study. However, there was significant heterogeneity between studies regarding the method(s) of H. pylori infection diagnosis based on and the study populations. The studies for the effect of H. pylori eradication on HOMA-IR revealed conflicting results.

CONCLUSIONS

Although data seem to indicate a potential association between H. pylori infection and IR, further studies are needed to strengthen this association and to clarify whether there is a causative link between them. If a causal link is confirmed in the future, this may have a major impact on the pathophysiology and management of IR syndrome, including type 2 diabetes mellitus and nonalcoholic fatty liver disease.

Effect of Helicobacter pylori eradication on insulin resistance, serum lipids and low-grade inflammation

BACKGROUND/AIM

Many studies have revealed a close relationship between Helicobacter pylori (HP) infection and insulin resistance. The aim of this study was to investigate the effects of HP eradication on insulin resistance, serum lipids and low-grade inflammation.

MATERIALS AND METHODS

This was a prospective, open-label, single-center study which consisted of 159 patients. The patients with HP infection received a 14-day sequential regimen. A HOMA-IR (homeostasis model assessment of insulin resistance) level was used to assess insulin resistance.

RESULTS

Eighty-eight patients with HP infection and seventy-one patients without HP infection were studied. HOMA-IR, total cholesterol (TC), triglyceride (TG), LDL cholesterol (LDL-C) and C reactive protein (CRP) levels were significantly higher and HDL-cholesterol (HDL-C) levels were significantly lower in patients with HP infection compared to the patients without HP infection (P<0.05). The HP eradication rates with a sequential regimen in dyspeptic patients were 53.4%. Six weeks after the end of eradication therapy, the mean fasting insulin, HOMA-IR, TC, TG, LDL-C, and CRP levels in patients with successful eradication were significantly decreased from the pretreatment levels (P<0.05) and HDL-C level was significantly increased from the pretreatment levels (P<0.05). The mean fasting insulin, HOMA-IR, TC, TG, LDL-C, CRP levels and HDL-C levels in patients with unsuccessful eradication were not significantly changed from pretreatment levels (P<0.05).

CONCLUSION

This study showed beneficial effects of HP eradication on insulin resistance, atherogenic lipid abnormalities and low-grade inflammation. The results suggest that HP eradication may prevent coronary artery disease and metabolic syndrome.

Effectiveness of full-mouth and partial-mouth scaling and root planing in treating chronic periodontitis in subjects with type 2 diabetes

BACKGROUND

This study evaluated the clinical and metabolic effects of full-mouth scaling and root planing (FMSRP) compared to partial-mouth scaling and root planing (PMSRP) in patients with type 2 diabetes and chronic periodontitis, and it assessed the impact of the glycemic status on the clinical and metabolic response to periodontal therapy.

METHODS

In this clinical trial, 18 subjects with diabetes received FMSRP in a maximum of 24 hours, and 18 subjects received PMSRP in a maximum of 21 days. Visible plaque accumulation, bleeding on probing, suppuration, probing depth, clinical attachment level (CAL), and glycosylated hemoglobin (HbA1c) levels were obtained at baseline and at 3 and 6 months post-therapy. Baseline HbA1c values > or =9% and <9% defined subjects with poorly and better-controlled diabetes, respectively.

RESULTS

All clinical parameters improved after therapy (P <0.05). No significant differences were observed between treatment groups for clinical and metabolic parameters at any time (P >0.05). There were no changes in the HbA1c levels after therapy (P >0.05). No subject reported any adverse effects during the study. Individuals with better-controlled diabetes achieved a lower mean CAL at 6 months post-therapy, when FMSRP and PMSRP were evaluated together (P <0.05).

CONCLUSIONS

FMSRP and PMSRP were equally effective in treating chronic periodontitis in subjects with type 2 diabetes, without significant improvements in the glycemic control at 3 and 6 months. Considering the periodontal therapy as a whole (FMSRP plus PMSRP), subjects with better-controlled diabetes exhibited a benefit in CAL at 6 months compared to subjects with poorly controlled disease.

Helicobacter pylori infection significantly increases insulin resistance in the asymptomatic Japanese population

BACKGROUND

Helicobacter pylori infection has been shown to contribute to atherosclerosis and cardiovascular diseases. Insulin resistance is the pathophysiologic background of the clinical features of atherosclerosis and cardiovascular diseases. We examined the association between H. pylori infection and insulin resistance in a large Japanese population.

MATERIALS AND METHODS

Fifteen hundred ninety-eight consecutive asymptomatic subjects that underwent a complete medical survey in our institute between May 2007 and July 2008 were recruited. Cases under medication for hypertension, hyperlipidemia, diabetes mellitus, hyperuricemia, or cardiovascular diseases were excluded from the study. Cases suffering from chronic renal or liver failure were also excluded. The homeostasis model assessment of insulin resistance (HOMA-IR) score was used to quantitatively estimate insulin resistance. Visceral and subcutaneous adipose tissues (SAT) were measured by computed tomography. The association between H. pylori serostatus and HOMA-IR score was investigated by multivariate regression analysis.

RESULTS

A total of 988 men and 119 women were eventually eligible for this cross-sectional survey. Helicobacter pylori seropositivity was significantly higher in 99 cases with insulin resistance (HOMA-IR >or=2.5) compared with 1008 cases without insulin resistance (HOMA-IR <2.5) (39.4 vs 28.7%, p = .027). There was a significant association between H. pylori serostatus and HOMA-IR score by multiple linear regression analysis (coefficients = 0.152, 95% CI = 0.058-0.246, p = .001), after adjusting for sex, age, body mass index, waist girth, visceral and subcutaneous adipose tissues, smoking status, alcohol consumption, dietary habits, and physical activity.

CONCLUSIONS

Helicobacter pylori infection significantly and independently contributed to promoting insulin resistance in a large asymptomatic population.

Helicobacter pylori infection as a risk factor for insulin resistance

This study aimed to determine the relation between Helicobacter pylori infection and insulin resistance in healthy subjects. In a cross-sectional case control study between January and April 2007, a total of 71 healthy subjects without the exclusion criteria completed the study. Forty-three (60.6%) patients were H. pylori positive and 28 (39.4%) patients were H. pylori negative. Age and body mass index of the patients were not significantly different between the two groups (32.2 +/- 14.2 vs. 33 +/- 8.05 years and 23.15 +/- 4.5 vs. 24.04 +/- 3.2 kg/m(2), respectively). H-pylori-positive patients had significantly higher HOMA-IR level compared to H-pylori-negative patients (3.54 +/- 2.2 vs. 2.46 +/- 1.9, respectively) (P < 0.05). Fasting serum insulin level was significantly higher in the H-pylori-positive group compared with the H-pylori-negative group (19.41 +/- 3.08 vs. 16.57 +/- 2.02 microU/ml, respectively) (P < 0.05). Our findings suggest recognition of H. pylori infection as a risk factor for insulin resistance.