Association between Helicobacter pylori infection and risk of new-onset diabetes: a community-based, prospective cohort study

Abstract

BackgroundHelicobacter pylori infection affects about 50% of the population worldwide. Results from previous studies, most of which were cross-sectional, on the association between H pylori infection and diabetes were inconsistent. We aimed to examine the association between H pylori infection and the risk of new-onset diabetes. MethodsIn this prospective cohort study, we recruited participants aged 45–74 years without diabetes from the Chinese Multi-provincial Cohort Study—Beijing Project, a community-based cohort study. H pylori serostatus (with seropositivity defined as anti-H pylori antibodies ≥10 U/mL, measured by latex-enhanced turbidimetric immunoassay), and diabetes status (with diabetes identified by self-report, fasting blood glucose concentration ≥7 mmol/L, or self-reported use of glucose-lowering drugs) were recorded at baseline, in 2007, and in 2012. We used multivariable logistic regression models to estimate the independent association between H pylori infection and diabetes risk. Ethics approval was granted by the ethics committee of Beijing An Zhen Hospital, Capital Medical University, and all participants provided written informed consent. FindingsOf 1671 participants (686 [41%] men; mean age 56·6 years [SD 7·8]), 966 (58%) were positive for H pylori infection at baseline. Between 2002 and 2012, 206 (12%) incident diabetes cases were recorded. After adjustment for other well known or potential risk factors of diabetes (including age, BMI, HDL, triglyceride, lipid-lowering therapy, smoking, hypertension, C-reactive protein, baseline fasting blood glucose level, and education level), H pylori infection was associated with a reduced risk of new-onset diabetes at 10 years (odds ratio 0·70, 95% CI 0·50–0·99) and at 5 years (0·82, 0·53–1·26 in 2002–07; 0·51, 0·30–0·87 in 2007–12). When participants with high fasting blood glucose (≥6·1 mmol/L) at baseline were excluded, H pylori infection was still associated with a reduced risk of new-onset diabetes (0·73, 0·51–1·03 in 2002–12; 0·83, 0·52–1·31 in 2002–07, 0·45, 0·22–0·93 in 2007–12). Of 1408 participants with anti-H pylori antibody measurements in both 2002 and 2007, 746 (53%) were persistently seropositive. Compared with participants who were persistently seronegative, those who were persistently seropositive had lower risk of new-onset diabetes at 5 years (0·50, 0·29–0·86). Of 725 participants who had anti-H pylori antibody measurements at all three timepoints (2002, 2007, and 2012), those who were persistently seropositive had a reduced risk of diabetes (0·70, 0·41–1·21). InterpretationH pylori infection is associated with a lower risk of new-onset diabetes in Chinese adults aged 45–74 years. The extrapolation of these results and the underlying mechanism for observed association need further investigation. FundingParticipants recruitment and data collection were supported by Beijing Municipal Science & Technology Commission (953850700), the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period (2006BAI01A01 and 2006BAI01A02), and the National Science & Technology Pillar Program during the Twelfth Five-Year Plan Period (2011BAI09B01). Study design, data analysis and interpretation, and other pertinent aspects of the study were funded by the National Natural Science Foundation of China (81170266, 81070226, and 81570409).