Helicobacter pylori in obese females

Abstract

Obesity is an increasing health problem in developing countries and has grown into a major global epidemic. Recent studies suggest that colonization of the stomach with Helicobacter pylori (H. pylori) may affect gastric expression of appetite and satiety-related hormones, finding that patients cured of H. pylori infection have gained weight. Further exploration of the relationship between obesity and H. pylori infection is therefore warranted.
The objective of this study was to determine the prevalence of H. pylori infection in a sample of obese patients. A total of 69 obese females and 55 normal-weight females as a control group were included. Body mass indices (BMI) of all females were measured and tests for H. pylori performed. Subjects ranged in age from 20 to 59 years. The threshold for classification of obesity was a BMI of 30 kg/m² or higher. Fifty obese females (72.5%) were H. pylori positive. Thirty-two (58.2%) normal-weight females were seropositive for H. pylori, which was not significant (p > 0.05) when compared with obese group. All the obese above 45 years of age were found to be H. pylori positive.
The study showed that there was no significant relation between H. pylori infection and obesity. Rather, the prevalence of H. pylori infection increases with age.
Key words:: obesity, Helicobacter pylori, BMI

Full text

310 Acta facultatis medicae Naissensis 2019; 36(4):310-315
ACTA FACULTATIS
MEDICAE NAISSENSIS
UDC: 613.25:[616.33-022.7:579.84
DOI: 10.5937/afmnai1904310A
Original artic l e
Helicobacter Pylori in Obese Females
Abdulhadi Alrubaie1, Maytham Al-Qanbar2, Raed Rassam3
1Head of Obesity Research and Therapy Unit, Alkindy College of Medicine/University of Baghdad, Iraq
2Departmentof Surgery, College of Medicine University of Kufa, Iraq
3Alkindy College of Medicine, University of Baghdad, Iraq
SUMMARY
Obesity is an increasing health problem in developing countries and has grown into a major global
epidemic. Recent studies suggest that colonization of the stomach with Helicobacter pylori (H. pylori) may affect
gastric expression of appetite and satiety-related hormones, finding that patients cured of H. pylori infection have
gained weight. Further exploration of the relationship between obesity and H. pylori infection is therefore
warranted.
The objective of this study was to determine the prevalence of H. pylori infection in a sample of obese
patients. A total of 69 obese females and 55 normal-weight females as a control group were included. Body mass
indices (BMI) of all females were measured and tests for H. pylori performed. Subjects ranged in age from 20 to 59
years. The threshold for classification of obesity was a BMI of 30 kg/m² or higher. Fifty obese females (72.5%) were
H. pylori positive. Thirty-two (58.2%) normal-weight females were seropositive for H. pylori, which was not
significant (p > 0.05) when compared with obese group. All the obese above 45 years of age were found to be H.
pylori positive.
The study showed that there was no significant relation between H. pylori infection and obesity. Rather,
the prevalence of H. pylori infection increases with age.
Key words: obesity, Helicobacter pylori, BMI
Corresponding author:
Abdulhadi Alrubaie
E-mail: hadirubaie@yahoo.com

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INTRODUCTION
Obesity is a major public health problem of
concern globally. In the United States alone, more than
60% of adults are overweight or obese with significant
impact on health and economy (1, 2). Obesity in adults is
defined as a BMI of at least 30 kg/m²; overweight is
defined as a BMI of 25 kg/m² or higher (3). Increases in
calorie intake, diet composition and declining levels of
physical activity may interact with changes in the gut
microbiome to contribute to obesity and overweight (4).
Obesity is linked to an increased risk of various health
problems, including hypertension, diabetes mellitus
type 2, dyslipidemia, ischemic heart disease, stroke,
asthma, and arthritis (5, 6).
Helicobacter pylori, a gram-negative spiral-shaped
bacteria found on gastric mucosa, was first isolated by
the Nobel Prize winners Robin Warren and Barry
Marshall (6). About half of the world population is
predicted to be infected with H. pylori bacteria. Peptic
ulcer diseases, atrophic gastritis, and gastric cancer could
be caused by chronic infection with H. pylori bacteria (7,
8). Studies have suggested its role in the pathogenesis of
systemic disorders like Reynaud phenomena, migraine
and cardiovascular disease (9-11).
The interplay between H. pylori and obesity is not
yet fully understood. While some data have revealed
that eradication of this bacteria increases BMI in patients
treated for peptic ulcer disease (12, 13), another study
found that the risk of H. pylori infection does not increase
in overweight young people (14). Obesity is considered a
risk factor for gastroesophageal reflux disease (GERD),
and the occurrence of GERD after H. pylori eradication
may be due to the restoration of acid secretion by the
gastric mucosa (15, 16).
Increase in appetite and weight gain has been reported
after H. pylori eradication in asymptomatic subjects, and
these findings may explain the increasing obesity seen in
the western population where H. pylori prevalence is low
(17).
METHODS
Between May 2014 and April 2018, 69 randomly
selected females with obesity (BMI 30 kg/m2 or higher)
attended the obesity research and therapy unit at
Alkindy College of Medicine University of Baghdad.
Fifty-five normal-weight females were included in the
study as a control group.
This study was approved ethically by the
scientific affairs unit of Alkindy College of Medicine,
University of Baghdad.
Laboratory assessment
The enzyme-linked immunosorbent assay kit
(Acon, USA), a noninvasive serological assay with a
sensitivity and specificity higher than 95% for the
detection of Helicobacter pylori infection, was used in this
study to determine the presence of H. pylori(18, 19).
Statistical analysis
Statistical analysis was performed by the use of
IBM SPSS 23.0.
RESULTS
The age ranges for all female participants were 20
to 59 years. Fifty out of 82 (72.5%) obese females were H.
pylori positive and 32 (58.2%) normal-weight females
were seropositive for H. pylori (Table 1), a difference
which was not statistically significant ( P = 0.09).
Table 1. Seroprevalence of H. pylori in relation to weight
Weight
H. pylori
Total
Negative
Positive
Normal weight
23 (41.8%)
32 (58.2%)
55
Obese
19 (27.5%)
50 (72.5%)
69
Total
42 (33.9%)
82 (66.1%)
124

Abdulhadi Alrubaie, Maytham Al-Qanbar, Raed Rassam
312 Acta facultatis medicae Naissensis 2019; 36(4):312-315
Table 2. Seropositivity of H. pylori in respect to age and weight in normal and obese females
Age /Years
Weight
H. pylori
Total
negative
positive
20-29
normal
10 (71.4%)
4 (28.6%)
14
obese
14 (77.8%)
4 (22.2%)
18
total
24 (75.0%)
8 (25.0%)
32
30-39
normal
6(37.5%)
10 (62.5%)
16
obese
3 (15.0%)
17 (85.0%)
20
total
9 (25.0%)
27 (75.0%)
36
40-49
normal
5 (35.7%)
9 (64.3%)
14
obese
2 (11.1%)
16 (88.9%)
18
total
7 (21.9%)
25 (78.1%)
32
50-59
normal
2 (18.2%)
9 (81.8%)
11
obese
0 (0.0%)
13 (100.0%)
13
total
2 (8.3%)
22 (91.7%)
24
Total
normal
23 (41.8%)
32 (58.2%)
55
obese
19 (27.5%)
50 (72.5%)
69
total
42 (33.9%)
82 (66.1%)
124
According to different age groups, the
seropositivity of H. pylori for obese females was 25%,
75%, 78.1% and 91.7% for ages 20-29, 30-39, 40-49 and 50-
59 years, respectively, which was not statistically
significant (P > 0,05) when compared with the control
group, but it is statistically significant when the
acquisition of H. pylori with advancing age P < 0.05
(Table 2) is calculated.
DISCUSSION
Recent research has drawn attention to the role of
H. pylori-associated gastritis in pathogenesis of
nutritional problems and body weight, due to its
supposed role and effects on the levels of gastric
hormone leptin produced by chief cells (20).
Numerous studies have shown that persons
infected with H. pylori produce lower amounts of ghrelin
and its eradication lead to increase ghrelin production
(21, 22).
Prevalence of H. pylori infection is related to
multiple factors, such as age and socioeconomic status.
Acquiring of infection in developing countries seems to
be nearly universal (23).
In this study, we found that most of H. pylori positive
cases (85%) were above 30 years of age, and 100% of
obese patients above 50 years of age were H. pylori
positive. If we compare the prevalence of H. pylori in
obese females in this study with a study done by
Nawafal et al. at North of Iraq, similar results were
found in about 78% of the general population above the
age of 40 being positive for H. pylori (24). In the nearby
countries, such as Turkey and Iran, the seropositivity for
H. pylori is 80.0% and 88.4% – 93%, respectively, while in
Egypt seropositivity has been reported in 90.0% and in
Algeria up to 92%.
The high seropositivity rates in developing
countries are in stark contrast to rates in developed
countries. For example, in the United States
seropositivity has been reported upto 30.0%, in Canada
23.1% and in Germany 48.8%.
Helicobacter pylori through its potential effects on
leptin hemostats may play a role in regulating the body
weight. In the United States, where obesity is considered
an important health problem, a large population-based
study found no significant correlation between H. pylori
status and being overweight (25). Our findings appear to
confirm this in a population with much higher
seropositivity rates.
The role of H. pylori infection in morbidly obese

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Acta facultatis medicae Naissensis 2019; 36(4):308-315 313
patients is still controversial. Generally, the existing
studies found that obese patients had a lower prevalence
of H. pylori infection than the general population (26).
Adipose tissue synthesizes the hormone leptin, which is
now known to be produced by the stomach as well, and
is involved in the regulation of satiety, food intake and
body weight. H.pylori induces gastric inflammation,
which may affect gastric leptin levels secretion and
influence food intake and body weight (21).
Nweneka et al. stated that people infected with
H. pylori have lower circulating ghrelin concentration
than non-infected individuals. In addition, H. pylori
eradication has no significant effects on ghrelin
concentration (27).
Weight gain following H. pylori eradication has been
demonstrated in numerous studies. Zuma et al. stated
that eradication of H. pylori is associated with reduced
gastric leptin levels followed by weight gain, though
serum leptin levels remain unchanged (28).
CONCLUSION
In conclusion, our study found that there was
no significant association between H.pylori infection and
obesity, but rather that the acquiring of H.pylori
bacterium was significantly related to the advancing age.
The authors declare that there is no conflict of interest.
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Prisustvo bakterije Helicobacter pylori kod gojaznih žena
Abdulhadi Alrubaie1, Maytham Al-Qanbar2, Raed Rassam3
1Načelnik odeljenja za ispitivanje gojaznosti i terapiju, Koledž medicinskih studija Alkindy, Univerzitet u Bagdadu, Irak
2Odeljenje za hirurgiju, Koledž medicinskih studija, Univerzitet u Kufi, Irak
3Koledž medicinskih studija Alkindy, Univerzitet u Bagdadu, Irak
SAŽETAK
Gojaznost postaje sve veći problem u zemljama u razvoju i dobija razmere globalne epidemije. Rezultati
nedavnih studija pokazali su da kolonizacija želuca bakterijom Helicobacter pylori (H. pylori) može da utiče na
apetit i hormone koji regulišu osećaj sitosti, i da bolesnice koje se izleče od ove infekcije dobiju na težini. Dalje
ispitivanje odnosa između gojaznosti i infekcije izazvane ovom bakterijom je neophodno.
Cilj ove studije bilo je određivanje prevalencije infekcije izazvane bakterijom H. pylori u grupi gojaznih
bolesnica. U istraživanje je uključeno ukupno 69 gojaznih žena i 55 žena sa normalnom težinom, koje su činile
kontrolnu grupu. Kod svih učesnica izmeren je indeks telesne mase i urađeno je testiranje na prisustvo ove
bakterije. Bolesnice su bile starosne dobi od 20 do 59 godina. Prag za klasifikaciju gojaznosti bio je indeks telesne
mase od 30 kg/m² ili iznad. Kod pedeset (72,5%) učesnica test na prisustvo bakterije H. pylori bio je pozitivan.
Trideset dve (58,2%) učesnice bile su seropozitivne, što nije bilo značajno (p > 0,05) u poređenju sa grupom
gojaznih žena. Sve bolesnice iznad 45 godina starosti bile su pozitivne na prisustvo bakterije H. pylori.
Rezulati studije nisu ukazali na značajan odnos između infekcije izazvane bakterijom H. pylori i
gojaznosti. Utvrđeno je da prevalencija infekcije izazvane bakterijom H. pylori raste sa godinama.
Ključne reči: gojaznost, Helicobacter pylori, indeks telesne mase