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Deng AJ, Tang C, Zhou B, Cai T, Chen B, Zhang SX, Yang XE, Li Y, Wang F. Helicobacter pylori infection, dining habits, and cohabitation in health examination and household cohorts. World J Gastroenterol 2027; 33(1): 122808 [DOI: 10.3748/wjg.122808]
Ao-Jian Deng, Chao Tang, Bai Zhou, Ting Cai, Bing Chen, Su-Xin Zhang, Xue-Er Yang, Fen Wang, Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Ying Li, Health Management Center, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Author contributions: Deng AJ analyzed data and wrote the paper; Deng AJ, Tang C, Zhou B, Cai T, Chen B, Zhang SX, and Yang XE conducted research; Li Y and Wang F conceived and designed research as co-corresponding authors; all authors critically reviewed and provided final approval of the manuscript, were responsible for the decision to submit the manuscript for publication.
AI contribution statement: AI tools (specifically DeepSeek) were used solely for language editing. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Supported by National Natural Science Foundation of China, No. 82270594; the Outstanding Youth Foundation of Hunan Province, No. 2022JJ20092; the Science and Technology Innovation Program of Hunan Province, No. 2024RC3065; the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hospital of Central South University, No. YX202103; Scientific Research Project of Hunan Provincial Health Commission, No. 20256738; the Independent Exploration and Innovation Project of Central South University, No. 2025ZZTS0150; and the Graduate Research Innovation Project of Hunan Province, No. CX20250417.
Institutional review board statement: This study was approved by the Ethics Committee of the Third Xiangya Hospital of Central South University (approval No. Kuai 22136).
Informed consent statement: The requirement to obtain informed written consent was waived, because the study was retrospective and did not involve any privacy and commercial interests.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: The data presented in this study are available on request from the corresponding author.
Corresponding author: Fen Wang, MD, Professor, Department of Gastroenterology, The Third Xiangya Hospital of Central South University, No. 138 Tongzi Road, Changsha 410013, Hunan Province, China. wfen-judy@csu.edu.cn
Received: April 29, 2026 Revised: May 26, 2026 Accepted: June 26, 2026 Published online: January 7, 2027 Processing time: 195 Days and 0.2 Hours
Abstract
BACKGROUND
Helicobacter pylori (H. pylori) infection is characterized by familial clustering, which is widely attributed to shared meals. However, the effectiveness of serving chopsticks in preventing transmission remains debated.
AIM
To investigate the risk factors for H. pylori infection and to elucidate the role of dietary habits vs intrafamilial transmission in its spread within households.
METHODS
The study included two populations: (1) 71663 individuals from a health examination cohort; and (2) 745 individuals from 262 community households. The questionnaires collected demographic, lifestyle, and dietary data. H. pylori infection was determined by a ¹³C-urea breath test. Multivariate regression models were used to identify risk factors.
RESULTS
The use of serving chopsticks was not significantly associated with H. pylori infection. Household analysis confirmed significant familial clustering (63.7% household infection rate; χ² = 13.426; P = 0.009). Larger household size, having more children under the age of 5, and a longer duration of cohabitation were associated with a greater number of H. pylori infections within a household.
CONCLUSION
This study indicates that the familial clustering of H. pylori infection may primarily be associated with close cohabitation and that the use of serving chopsticks is not related to H. pylori infection.
Core Tip: This retrospective study included both a health examination population and a community household population. The use of serving chopsticks was not associated with Helicobacter pylori (H. pylori) infection. H. pylori infection exhibits familial clustering and is associated with close cohabitation rather than shared dining habits. These results suggest that future H. pylori prevention strategies should focus on comprehensive household-level strategies to address the role of close interpersonal contact in H. pylori transmission.
Citation: Deng AJ, Tang C, Zhou B, Cai T, Chen B, Zhang SX, Yang XE, Li Y, Wang F. Helicobacter pylori infection, dining habits, and cohabitation in health examination and household cohorts. World J Gastroenterol 2027; 33(1): 122808
Helicobacter pylori (H. pylori) is a risk factor for various gastric diseases, including atrophic gastritis and gastric mucosal intestinal metaplasia, and is an established carcinogen for gastric cancer[1,2]. The prevalence of H. pylori infection varies significantly across regions, ranging from 20% to 60%, indicating an overall high prevalence trend[3-6]. Differences in the source populations examined may be among the reasons for the significant differences in H. pylori infection rates[4]. Patients from hospital settings may already have gastrointestinal discomfort, leading to a biased H. pylori infection rate[7-9]. In contrast, individuals who undergo routine health examinations within hospital settings represent a less highly selected population and are more representative[10,11]. Previous studies have demonstrated distinct familial clustering of H. pylori infection[12,13], which is likely associated with shared living habits and dietary practices among family members[14-16].
The prevalence of H. pylori infection in China was historically close to 50%, but recent studies have indicated a decreasing trend. Recent multicenter studies have reported infection rates between 20% and 30%, with substantial variation across provinces and demographic groups[4,17-19]. Hunan Province is located in Central China, and its dietary culture is characterized by a preference for spicy foods, high-fat, high-sodium dishes, and pickled foods. The prevalence of H. pylori infection is relatively low in Central China[20], and there is a lack of epidemiological investigations focusing on H. pylori infection at the household level within this region.
This study aimed to investigate health examination and community populations in Hunan Province using designed questionnaires to provide a more accurate description of the prevalence of H. pylori infection in Hunan Province and to explore the risk factors associated with H. pylori infection.
MATERIALS AND METHODS
This study was approved by the Ethics Committee of the Third Xiangya Hospital of Central South University (approval No. Kuai 22136).
Study design and patients
We recruited two independent cohorts for multiangle analysis: (1) One from a hospital-based health examination center; and (2) The other from community-based households (Figure 1).
Figure 1 Participant flow chart.
A: Health examination population; B: Community population. PPI: Proton pump inhibitor; 13C-UBT: ¹³C-urea breath test.
Health examination population: Between September 2018 and April 2024, 83519 individuals who underwent health examinations at the Health Management Center of the Third Xiangya Hospital of Central South University were included in the study. The exclusion criteria were as follows: (1) Use of antibiotics within the past 4 weeks; (2) Use of proton pump inhibitors within the past 2 weeks; (3) Severely incomplete questionnaire data; and (4) Pregnancy, postpartum status, or planning pregnancy and thus an inability to undergo the ¹³C-urea breath test. After these criteria were applied, 71663 examinees were included in the final analysis.
To further investigate the association between H. pylori infection and specific dining habits, a substudy was conducted using a detailed dietary questionnaire. Between September 2020 and January 2021, 521 individuals completed the questionnaire. After applying the criteria above, 430 participants were ultimately included in the final substudy analysis.
Community population: Between July and September 2021, a total of 353 households from the Yingcai and Linhai communities in Changsha voluntarily agreed to participate, comprising 1005 individuals. The inclusion criteria included family members aged 3 years or older and at least two members who had lived together for more than 10 months. When the same exclusion criteria used for the health examination population were applied, 995 individuals were valid participants. After excluding households in which only some members participated in testing, 262 households comprising 745 individuals were ultimately included for subsequent analysis. H. pylori was detected in the community population using the ¹³C-urea breath test. A household was defined as an “infected household” if it contained at least one H. pylori-positive member.
Questionnaire content
The questionnaire for the health examination population collected demographic information, lifestyle habits, and dietary habits. A questionnaire for the community population was used at the household level, and data on basic household information and shared habits during family life were gathered.
Statistical analyses
Statistical analyses were performed using R software (version 4.4.2). Categorical data are n (%), and continuous data are presented as the mean ± SD. Unless otherwise specified, Student’s t test was used for continuous variables, and the χ2 test was used for categorical variables. The variables adjusted for in the multivariate regression models are detailed in the tables within the Results section. A P value < 0.05 was considered to indicate statistical significance.
RESULTS
Risk factor analysis for H. pylori infection in the health examination population
After the inclusion and exclusion criteria were applied, 71663 examinees, primarily from various cities across Hunan Province, were ultimately included in the analysis (Figure 2). Among them, 16335 tested positive for H. pylori, yielding a positivity rate of 22.8%. The H. pylori-positive group was older and had a higher proportion of females, a higher proportion of married or cohabiting individuals, lower education levels, and a lower proportion of individuals with stable occupations (Supplementary Table 1).
Figure 2
Source of the health examination population.
To further analyze risk factors for H. pylori infection, variables showing statistical significance in the univariate analysis (Supplementary Table 1) were incorporated into multivariate logistic regression models. Separate models were constructed: (1) One including all significant variables (model 1); and (2) Another focusing specifically on lifestyle-related variables (model 2). Both models revealed that irregular meal patterns, frequent social dining, a preference for spicy foods, and a preference for animal offal were risk factors for H. pylori infection. Conversely, the frequent consumption of late-night snacks and a preference for legumes, vegetables, and fruits were protective factors against H. pylori infection. The detailed results are shown in Table 1.
Table 1 Association between Helicobacter pylori infection and demographic/behavioral factors in health examination populations.
Analysis of dining habits and H. pylori infection in the health examination population
From the health examination population, 430 individuals were randomly selected for further investigation into dining habits. The H. pylori infection rate in this subgroup was 27.2%. However, no significant association was found between H. pylori infection and tableware hygiene practices, including the use of serving chopsticks. The detailed results are shown in Table 2.
Table 2 Dining habits and Helicobacter pylori infection risk factors in the health examination population, n (%).
Analysis of familial clustering of H. pylori infection in the community population
Data from 995 individuals in 353 households were initially collected. After applying the inclusion/exclusion criteria and excluding households with incomplete participation, 262 households comprising 745 individuals were analyzed. Among these, 239 individuals were H. pylori positive (individual infection rate: 32.1%). There were 167 H. pylori-infected households (household infection rate: 63.7%). All members of 21 households (8.02% of all households) were infected. A χ2 test revealed a significant difference between the observed and expected frequencies of household infections (χ² = 13.426, P = 0.009), indicating the presence of familial clustering of H. pylori infection (Figure 3).
Risk factor analysis for H. pylori infection in the community population
Univariate analysis of 262 households revealed that the variables were not statistically significant (Supplementary Table 2). We further constructed three regression models to explore the relationships between the variables and the number of family infections. Model 1 included all the variables, model 2 included demographic and selected socioeconomic variables, and model 3 included dietary habits. Multivariate linear regression analysis of the factors influencing the number of infected individuals per household suggested that a larger household size, the presence of children under 5 years old in the family, and a longer duration of cohabitation might be associated with a greater number of H. pylori infections within a household, whereas the presence of children aged 6-18 in the family might be associated with a lower number of H. pylori infections (Table 3). In model 1 and model 3, which included dietary habits, the results were consistent with those from the health examination population, showing no association between the use of serving chopsticks and H. pylori infection.
Table 3 Association between Helicobacter pylori infection and demographic/behavioral factors in the enrolled households.
To further explore the factors influencing H. pylori transmission between spouses, we analyzed 82 couple households without children. Among these, 50 households (61.0%) were infected (at least one positive spouse). Univariate analysis revealed a potential association between the source of drinking water and H. pylori infection (Supplementary Table 3). We constructed three regression models to analyze the relationships between the variables and family infection situations. Multivariate analysis yielded similar results: The consumption of purified water was identified as a protective factor against H. pylori infection, although most risk factors lacked statistical significance (Table 4). Notably, the use of serving chopsticks was also not significantly different in this analysis.
Table 4 Association between Helicobacter pylori infection and demographic/behavioral factors in couples.
We further screened 67 families with children. Univariate analysis suggested that the proportion of children aged less than 5 years was relatively high in the infected households (Supplementary Table 4). Multivariate linear regression analysis of the factors influencing the number of infected individuals per household further suggested that having children aged 6-18 in the family might be associated with a lower number of H. pylori infections (Table 5).
Table 5 Association between Helicobacter pylori infection and demographic/behavioral factors in the enrolled households.
This study comprises two main parts. First, data were collected from a single-center health examination population in Hunan Province, and dietary and lifestyle risk factors for H. pylori infection were analyzed. The second part collected household-based data from communities. Compared with the health examination population, the community population had a higher H. pylori infection rate, and the household-level infection rate was even higher, confirming the existence of familial clustering of H. pylori infection.
With respect to dietary habits, irregular meal patterns and frequent social dining were identified as risk factors, whereas consuming late-night snacks emerged as a protective factor. Irregular meals may contribute to gastroduodenal diseases such as peptic ulcers, damage the gastric mucosal barrier, and potentially increase susceptibility to H. pylori infection, and H. pylori infection may also reciprocally aggravate the development and progression of related gastric disorders[21-25].
Furthermore, irregular dietary habits can indirectly modulate H. pylori infection through their effects on gastrointestinal microbial ecology[26]. Although studies investigating the association between social dining and H. pylori infection are limited, frequent social gatherings may facilitate the transmission of H. pylori through shared food or close personal contact. Notably, studies have shown that late-night snacking has a protective effect against H. pylori infection[10], which is consistent with the findings of this study. Although the precise mechanism remains unclear, we speculate that it may be related to food-stimulated gastric acid secretion. Gastric acid secretion reaches its lowest point in the hours before dawn, and late-night snacking can stimulate gastric acid secretion during this period[27]; a highly acidic environment is unfavorable for H. pylori colonization and may reduce infection risk[28,29], although the exact mechanism deserves further exploration.
Our data indicate that preferences for spicy foods and animal offal are risk factors, whereas the consumption of beans or bean products, vegetables, and fruits is a protective factor against H. pylori infection, which aligns with findings from some prior studies[10,23,30]. The relationship between capsaicin and gastric disorders remains controversial[31-33], and further research is needed to elucidate the mechanisms linking capsaicin to H. pylori infection. Animal offal, which is high in fat, might disrupt normal gastric microecology[34], ultimately increasing the probability of H. pylori infection. The high vitamin content in vegetables and fruits could explain their inverse association with H. pylori infection[35,36].
Numerous studies have confirmed the familial clustering of H. pylori infection[12,13,37], a conclusion supported by our findings. These findings underscore the importance of household-based strategies for H. pylori prevention and management. Further analysis of household risk factors suggested that a longer cohabitation duration and a larger household size were associated with a greater number of infected individuals within households. Among couples-only households, the use of purified or boiled water was identified as a protective factor against household H. pylori infection. A possible explanation is that H. pylori, as a microaerophile, cannot survive long ex vivo and is sensitive to heat[38]. Purified and boiled water can undergo sterilization, potentially reducing the infection risk[39,40]. In families with children, we found that having children younger than 5 years of age is associated with more infected individuals within the family. This may be related to the practice of mouth-to-mouth feeding among young children[41].
However, the vast majority of dining habits analyzed in both the health examination population and the household-based analysis were not significantly different. While some previous studies have suggested that using serving chopsticks may prevent H. pylori infection[13,17], our study did not support this finding. Considering that some studies in Europe have also reported the familial clustering of H. pylori infections[42-45] and given that European dining habits typically involve individual portion dining, this finding indirectly lends support to the idea that using serving chopsticks or separate meal servings may not significantly impact the transmission of H. pylori. As noted earlier, H. pylori cannot survive long ex vivo and is heat sensitive[38]. Traditional Chinese cooking involves heating food, making foodborne transmission unlikely. We speculate that the familial clustering of H. pylori infection may be associated with close interpersonal contact among family members and practices such as premastication feeding among children[13,41].
This study has the following limitations. First, the participants did not investigate whether H. pylori had previously been eradicated, which may have affected the interpretation of the results. Second, the community population originated mainly from Changsha and surrounding areas, which may not be entirely representative. Third, no investigation was conducted on whether intimate contact habits (such as premastication feeding, sharing toothbrushes, or kissing frequency) were present in families, resulting in a limited evaluation of intimate contact habits.
CONCLUSION
In conclusion, the results of this study indicate that H. pylori infection exhibits strong familial clustering in Central China, which may be associated with close cohabitation rather than shared dining habits. Furthermore, this study revealed that the use of serving chopsticks is not related to H. pylori infection. These results suggest that future H. pylori prevention strategies should focus on comprehensive household-level strategies to address the role of close interpersonal contact in H. pylori transmission.
ACKNOWLEDGEMENTS
We would like to thank all the participants in this study.
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