Association of Helicobacter pylori infection with insulin resistance, tumor necrosis factor-alpha, and dyslipidemia in obese children with metabolic syndrome

doi:10.5409/wjcp.v15.i3.121926

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Pediatr. Sep 9, 2026; 15(3): 121926
Published online Sep 9, 2026. doi: 10.5409/wjcp.v15.i3.121926

Table 1 Baseline demographic and clinical characteristics of the studied groups

Variable	*Group Ia (H. pylori-negative) (n = 35)*	*Group Ib (H. pylori-positive) (n = 35)*	P value
Age, years, median (IQR)	8.0 (8.0-9.0)	8.0 (5.5-10.0)	0.721
Sex (male/female)	16 (45.7)/19 (54.3)	18 (51.4)/17 (48.6)	0.632
Standardized BMI value, median (IQR)	0.10 (-0.28 to 0.50)	0.31 (-0.22 to 0.66)	0.242
Elevated blood pressure	11 (31.4)	23 (65.7)	0.004^a
Hepatomegaly	10 (28.6)	22 (62.9)	0.004^a

^aP < 0.05.

Data are presented as median (interquartile range) or n (%).The Mann-Whitney U test was used for continuous variables, and the χ² test for categorical variables. BMI: Body mass index; IQR: Interquartile range; H. pylori: Helicobacter pylori.

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Table 2 Laboratory investigations among the studied groups

Variable	*Group Ia (H. pylori-negative) (n = 35)*	*Group Ib (H. pylori-positive) (n = 35)*	P value
ALT (U/L), median (IQR)	40.6 (28.9-53.7)	74.1 (57.8-85.2)	< 0.001^a
AST (U/L), median (IQR)	36.8 (33.2-40.4)	72.7 (56.5-89.9)	< 0.001^a
Total cholesterol (mg/dL), mean ± SD	180.7 ± 56.9	193.1 ± 49.2	0.333
Triglycerides (mg/dL), mean ± SD	135.2 ± 15.9	163.1 ± 23.9	< 0.001^a
LDL-C (mg/dL), mean ± SD	123.4 ± 14.2	137.9 ± 18.9	< 0.001^a
HDL-C (mg/dL), mean ± SD	48.4 ± 19.3	33.2 ± 13.5	< 0.001^a
Fasting plasma glucose (mg/dL), mean ± SD	109.5 ± 22.7	158.5 ± 40.1	< 0.001^a
HbA1c (%), mean ± SD	7.4 ± 1.7	8.5 ± 2.2	0.019^a
2-hour postprandial glucose (mg/dL), mean ± SD	98.5 ± 5.2	102.2 ± 8.4	0.033^a
Fasting insulin (μIU/mL), mean ± SD	3.9 ± 1.0	9.4 ± 3.6	< 0.001^a
HOMA-IR, mean ± SD	1.06 ± 0.36	3.61 ± 1.45	< 0.001^a

^aP < 0.05.

Data are presented as median (interquartile range) for alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and as mean ± SD for the remaining continuous variables. HOMA-IR was calculated as fasting insulin (μIU/mL) × fasting plasma glucose (mg/dL)/405. Mann-Whitney U test was used for ALT and AST; independent t-test was used for the remaining continuous variables. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin; HOMA-IR: Homeostasis model assessment of insulin resistance; IQR: Interquartile range; H. pylori: Helicobacter pylori.

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Table 3 Tumor necrosis factor-alpha, adiponectin, and leptin among the studied groups

Variable	*Group Ia (H. pylori-negative) (n = 35)*	*Group Ib (H. pylori-positive) (n = 35)*	P value
TNF-α, median (IQR)	6.23 (4.04-6.76)	7.13 (5.91-8.68)	0.011^a
Adiponectin, median (IQR)	7.57 (3.56-10.69)	8.74 (4.87-10.71)	0.647
Leptin, median (IQR)	12.86 (9.07-20.21)	13.97 (6.09-18.17)	0.756

^aP < 0.05.

Data are presented as median (interquartile range). P values were calculated using the Mann-Whitney U test. Units are as reported by the assay kits. TNF-α: Tumor necrosis factor-alpha; IQR: Interquartile range; H. pylori: Helicobacter pylori.

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Table 4 Multivariable models for association of Helicobacter pylori positivity with key outcomes (adjusted for age, sex, and standardized body mass index value)

Outcome	Effect measure	Adjusted estimate (95%CI)	P value
Elevated blood pressure	OR	4.37 (1.57-12.21)	0.005^a
Hepatomegaly	OR	4.53 (1.60-12.83)	0.004^a
HOMA-IR (log model)	Ratio	2.98 (2.48-3.57)	< 0.001^a
TNF-α	β	+0.91 (0.07-1.75)	0.037^a
Triglycerides (mg/dL)	β	+28.54 (18.30-38.79)	< 0.001^a
LDL-C (mg/dL)	β	+13.76 (5.25-22.26)	0.002^a
HDL-C (mg/dL)	β	-16.22 (-23.99 to -8.45)	< 0.001^a
ALT (log model)	Ratio	1.86 (1.39-2.49)	< 0.001^a
AST (log model)	Ratio	1.77 (1.52-2.06)	< 0.001^a
Fasting plasma glucose (log model)	Ratio	1.40 (1.23-1.59)	< 0.001^a
HbA1c (%)	β	+0.79 (-0.08 to 1.65)	0.080

^aP < 0.05.

Models adjusted for age, sex, and standardized body mass index value. “β” represents adjusted mean difference. “Ratio” represents the back-transformed effect from log-linear models. OR: Odds ratio; CI: Confidence interval; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin; HOMA-IR: Homeostasis model assessment of insulin resistance; IQR: Interquartile range; TNF-α: Tumor necrosis factor-alpha.

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Table 5 Pearson correlation between homeostasis model assessment of insulin resistance and study variables within each group

Variable	r (group Ia)	P value (Ia)	r (group Ib)	P value (Ib)
Age (years)	0.023	0.895	-0.228	0.188
Standardized BMI value	0.293	0.088	0.889	< 0.001^a
ALT (U/L)	-0.076	0.663	-0.196	0.260
AST (U/L)	-0.237	0.170	0.038	0.827
Total cholesterol (mg/dL)	0.075	0.670	0.206	0.235
Triglycerides (mg/dL)	-0.148	0.397	0.080	0.648
LDL-C (mg/dL)	0.044	0.800	-0.028	0.873
HDL-C (mg/dL)	0.113	0.518	0.102	0.559
Fasting plasma glucose (mg/dL)	0.716	< 0.001^a	0.401	0.017^a
HbA1c (%)	0.115	0.511	0.653	< 0.001^a
2-hour postprandial glucose (mg/dL)	0.119	0.494	0.071	0.687
Fasting insulin (μIU/mL)	0.833	< 0.001^a	0.788	< 0.001^a
TNF-α (assay units)	0.185	0.288	0.896	< 0.001^a
Adiponectin (assay units)	-0.234	0.176	-0.080	0.648
Leptin (assay units)	0.149	0.394	0.259	0.132

^aP < 0.05.

R values represent Pearson correlation coefficients between homeostasis model assessment of insulin resistance (calculated as fasting insulin × fasting glucose/405) and the listed variables within each group. Group Ia: Helicobacter pylori (H. pylori)-negative; Group Ib: H. pylori-positive. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin; BMI: Body mass index; TNF-α: Tumor necrosis factor-alpha.

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Table 6 Receiver operating characteristic analysis for discrimination of Helicobacter pylori infection

Parameter	Optimal cutoff (Youden)	AUC	95%CI (bootstrap)	P value (AUC vs 0.5)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)
HOMA-IR	> 1.67	0.954	0.892-0.999	< 0.001^a	88.57	97.14	96.88	89.47	92.86
TNF-α	> 6.81	0.677	0.544-0.795	0.006^a	54.29	80.00	73.08	63.64	67.14

^aP < 0.05.

Optimal cutoffs were chosen by Youden’s index (sensitivity + specificity - 1). PPV/NPV depend on prevalence and here reflect the study sample (equal group sizes). Because cutoffs were derived within the same cohort, estimates may be optimistic and should be considered exploratory. AUC: Area under the curve; CI: Confidence interval; PPV: Positive predictive value; NPV: Negative predictive value; HOMA-IR: Homeostasis model assessment of insulin resistance; TNF-α: Tumor necrosis factor-alpha.

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Citation: Ibrahim Elbakry NM, Hemeda MS, Mostafa Mohamed Ahmed A, Adel Zaky H, Gamil AN, Arafat Abd Elmoaty AE, M Khafagi M, Mohamed Alkabeer A, Abd Elaziz Alsaid A, A Elhagary A, Mohammed Aboassy W, Nabil Gamil Mohammed A. Association of Helicobacter pylori infection with insulin resistance, tumor necrosis factor-alpha, and dyslipidemia in obese children with metabolic syndrome. World J Clin Pediatr 2026; 15(3): 121926
URL: https://www.wjgnet.com/2219-2808/full/v15/i3/121926.htm
DOI: https://dx.doi.org/10.5409/wjcp.v15.i3.121926

Ibrahim Elbakry NM, Hemeda MS, Mostafa Mohamed Ahmed A, Adel Zaky H, Gamil AN, Arafat Abd Elmoaty AE, M Khafagi M, Mohamed Alkabeer A, Abd Elaziz Alsaid A, A Elhagary A, Mohammed Aboassy W, Nabil Gamil Mohammed A. Association of Helicobacter pylori infection with insulin resistance, tumor necrosis factor-alpha, and dyslipidemia in obese children with metabolic syndrome. World J Clin Pediatr 2026; 15(3): 121926 [DOI: 10.5409/wjcp.v15.i3.121926]

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