Cai ZB, Su BB, Shi PY, Wang SS, Shi H, Chen QQ. Metabolic dysfunction-associated steatotic liver disease mediates the relationship between Helicobacter pylori infection and colorectal adenoma risk. World J Hepatol 2026; 18(4): 115475 [DOI: 10.4254/wjh.v18.i4.115475]
Corresponding Author of This Article
Qian-Qian Chen, MD, Associate Chief Physician, Associate Professor, Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. qian_qian_chen@163.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Apr 27, 2026 (publication date) through Apr 22, 2026
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Journal Information of This Article
Publication Name
World Journal of Hepatology
ISSN
1948-5182
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Cai ZB, Su BB, Shi PY, Wang SS, Shi H, Chen QQ. Metabolic dysfunction-associated steatotic liver disease mediates the relationship between Helicobacter pylori infection and colorectal adenoma risk. World J Hepatol 2026; 18(4): 115475 [DOI: 10.4254/wjh.v18.i4.115475]
Zhao-Bei Cai, Department of Geriatrics, Aerospace Center Hospital, Peking University Aerospace Clinical Medical College, Beijing 100049, China
Bin-Bin Su, Hui Shi, Department of Gastroenterology and Hepatology, The Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Pan-Yang Shi, Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
Sheng-Shu Wang, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Qian-Qian Chen, Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Co-first authors: Zhao-Bei Cai and Bin-Bin Su.
Co-corresponding authors: Hui Shi and Qian-Qian Chen.
Author contributions: Cai ZB, Su BB, Shi H, and Chen QQ designed the study; Shi H and Chen QQ verified the disease diagnosis, have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors; Su BB and Wang SS performed the primary literature and data extraction; Cai ZB, Su BB, and Wang SS analyzed the data and drafted the manuscript; Shi PY, Shi H, and Chen QQ revised the manuscript for important intellectual content; Shi PY handled the submission process; Cai ZB and Su BB have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; all authors read and approved the final version.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the PLA General Hospital (No. S2023-224-01).
Informed consent statement: Patients were exempt from providing informed consent for the study, as it involved the use of de-identified clinical data collected subsequent to each patient's written agreement for testing.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Corresponding author: Qian-Qian Chen, MD, Associate Chief Physician, Associate Professor, Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. qian_qian_chen@163.com
Received: October 31, 2025 Revised: December 15, 2025 Accepted: January 20, 2026 Published online: April 27, 2026 Processing time: 172 Days and 6.4 Hours
Abstract
BACKGROUND
There is a potential connection between Helicobacter pylori (H. pylori) infection, metabolic dysfunction-associated steatotic liver disease (MASLD) and colorectal adenoma.
AIM
To determine whether H. pylori infection and MASLD increase the probability of developing colorectal adenomas, and to analyze whether there is an interaction or mediation effect between these two risk factors.
METHODS
The study followed a retrospective cross-sectional design. Patients attending the Second Medical Center of Chinese PLA General Hospital for check-up between 2017 and 2021 were consecutively enrolled. We collected patients' basic information, laboratory test results, colonoscopy findings, H. pylori test results, and ultrasound data. Multivariate logistic regression analysis, interaction, and mediation effect tests were employed to assess the relationship between H. pylori infection, MASLD, and the risk of colorectal adenomas.
RESULTS
Of the 10066 participants, 29.40% had colorectal adenomas, 36.78% had H. pylori infection and 53.55% had MASLD. Adjusted multivariate analysis showed that both H. pylori [adjust odds ratio (aOR) = 1.3, 95%CI: 1.2-1.4, P < 0.001] and MASLD (aOR = 1.3, 95%CI: 1.2-1.5, P < 0.001) independently raised adenoma risk, with no interaction (P = 0.1836). MASLD might act as a mediator of the increased colorectal adenoma risk associated with H. pylori infection (mediation effect = 0.0009, 95%CI: 0.0002-0.0027, P = 0.0180).
CONCLUSION
H. pylori infection and MASLD independently elevate the risk of colorectal adenomas, with MASLD potentially mediating the relationship between H. pylori infection and the increased adenoma risk.
Core Tip: This study identifies both Helicobacter pylori (H. pylori) infection and metabolic dysfunction-associated steatotic liver disease (MASLD) as independent risk factors for colorectal adenoma. No interaction was found between them, but MASLD mediated the infection-adenoma risk relationship. These results support enhanced screening for colorectal adenoma in individuals with H. pylori infection and MASLD.
