Metabolic dysfunction-associated steatotic liver disease mediates the relationship between Helicobacter pylori infection and colorectal adenoma risk

Table 1 Baseline characteristics, n (%)/mean ± SD

	Non-polyp (n = 6930)	Adenoma (n = 3136)	P value
Helicobacter pylori infection			< 0.001
Yes	2408 (34.75)	1294 (41.26)
No	4522 (65.25)	1842 (58.74)
MASLD			< 0.001
Yes	3461 (49.94)	1929 (61.51)
No	3469 (50.06)	1207 (38.49)
Basic characteristics
Sex (male)			< 0.001
Male	4465 (64.43)	2552 (81.38)
Female	2465 (35.57)	584 (18.62)
Age (years)	49.31 ± 8.19	52.51 ± 7.38	< 0.001
BMI (kg/m2)	24.95 ± 3.31	25.84 ± 3.21	< 0.001
Systolic blood pressure (mmHg)	122.52 ± 139.14	125.09 ± 18.13	0.336
Diastolic blood pressure (mmHg)	80.70 ± 11.44	82.70 ± 11.79	< 0.001
Smoking history	1781 (25.70)	1214 (38.71)	< 0.001
Drinking history	3763 (54.30)	2056 (65.56)	< 0.001
Laboratory assays
White blood cell count (× 109/L)	5.82 ± 1.46	6.07 ± 1.48	< 0.001
Hemoglobin (g/L)	142.73 ± 15.85	146.96 ± 13.97	< 0.001
CRP (mg/dL)	0.14 ± 0.28	0.17 ± 0.36	< 0.001
Folic acid (ng/mL)	9.36 ± 4.27	8.90 ± 4.26	< 0.001
Homocysteine (μmol/L)	12.24 ± 9.31	13.24 ± 6.91	< 0.001
NT-proBNP (pg/mL)	34.64 ± 40.02	35.65 ± 52.70	0.299
TC (mmol/L)	4.72 ± 0.89	4.75 ± 0.91	0.152
Triglycerides (mmol/L)	1.76 ± 1.22	1.99 ± 1.39	< 0.001
LDL-C (mmol/L)	3.15 ± 0.84	3.18 ± 0.86	0.139
HDL-C (mmol/L)	1.26 ± 0.35	1.18 ± 0.32	< 0.001
FBG (mmol/L)	5.41 ± 1.21	5.63 ± 1.37	< 0.001
Creatinine (μmol/L)	67.63 ± 14.01	70.91 ± 14.03	< 0.001
25-hydroxyvitamin D3 (ng/mL)	19.72 ± 6.07	20.14 ± 6.12	0.002

MASLD: Metabolic dysfunction-associated steatotic liver disease; BMI: Body mass index; CRP: C-reactive protein; NT-proBNP: Brain natriuretic peptide precursor; TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; FBG: Fasting blood glucose.

Table 2 Association between Helicobacter pylori infection and adenoma (multivariate logistic regression model)

Helicobacter pylori infection test	Adjusting for confounding factors 11		Adjusting for confounding factors 22
	OR (95%CI)	P value	OR (95%CI)	P value
-	1.0		1.0
+	1.3 (1.2-1.5)	< 0.001	1.3 (1.2-1.4)	< 0.001

¹Adjusting for confounding factors 1: Age, sex and body mass index.

²Adjusting for confounding factors 2: Age, sex, body mass index, systolic blood pressure, white blood cell count, hemoglobin, C-reactive protein, folic acid, homocysteine, total cholesterol, fasting blood glucose, creatinine, 25-hydroxyvitamin D3, smoking history, and drinking history.

OR: Odds ratio.

Table 3 Association between metabolic dysfunction-associated steatotic liver disease and adenoma (multivariate logistic regression model)

MASLD	Adjusting for confounding factors 11		Adjusting for confounding factors 22
	OR (95%CI)	P value	OR (95%CI)	P value
-	1.0		1.0
+	1.3 (1.2-1.4)	< 0.001	1.3 (1.2-1.5)	< 0.001

¹Adjusting for confounding factors 1: Age and sex.

²Adjusting for confounding factors 2: Age, sex, white blood cell count, hemoglobin, folic acid, homocysteine, total cholesterol, creatinine, 25-hydroxyvitamin D3, smoking history, and drinking history.

MASLD: Metabolic dysfunction-associated steatotic liver disease; OR: Odds ratio.

Table 4 Multivariate logistic regression model for colorectal adenoma and the interaction between Helicobacter pylori and metabolic dysfunction-associated steatotic liver disease

	Adjusting for confounding factors 11		Adjusting for confounding factors 22
	OR (95%CI)	P value	OR (95%CI)	P value
H. pylori (-) MASLD (-)	1.0		1.0
H. pylori (+) MASLD (-)	1.24 (1.11-1.39)	0.0002	1.28 (1.12-1.45)	0.0002
H. pylori (-) MASLD (+)	1.28 (1.11-1.48)	0.0006	1.18 (1.02-1.40)	0.0430
H. pylori (+) MASLD (+)	1.68 (1.47-1.91)	< 0.0001	1.68 (1.45-1.93)	< 0.0001
Interaction between H. pylori infection and MASLD		0.2780		0.1836

¹Adjusting for confounding factors 1: Age and sex.

²Adjusting for confounding factors 2: Age, sex, white blood cell count, hemoglobin, folic acid, homocysteine, total cholesterol, creatinine, 25-hydroxyvitamin D3, smoking history, and drinking history.

H. pylori: Helicobacter pylori; MASLD: Metabolic dysfunction-associated steatotic liver disease; OR: Odds ratio.

Table 5 Mediation effect of metabolic dysfunction-associated steatotic liver disease in the influence of Helicobacter pylori on colorectal adenoma occurrence

	OR (95%CI)	P value1
Total effect	0.0563 (0.0387-0.0763)	< 0.0001
Direct effect	0.0554 (0.0037-0.0753)	< 0.0001
Mediation effect	0.0009 (0.0002-0.0027)	0.0180
Mediation effect percentage	0.0168 (0.0037-0.0510)	0.0180

¹Adjusting for confounding factors 1: Age and sex.

MASLD: Metabolic dysfunction-associated steatotic liver disease; OR: Odds ratio.