Association of Helicobacter pylori infection with metabolic syndrome and its components: a retrospective cross-sectional study based on a health check-up population in Nanjing

The association between Helicobacter pylori ( H. pylori ) infection and metabolic syndrome (MetS) remains unclear, and its associations with individual MetS components are not fully understood. A total of 5,218 adults who underwent health checkups at the Physical Examination Center of Nanjing First Hospital from April 2024 to April 2025 were enrolled. General information, H. pylori infection status, anthropometric measurements, and laboratory test results were collected. The diagnosis of MetS was based on Guidelines for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (2020 edition) . A series of logistic regression models with different covariate adjustments was used to examine the association between H. pylori infection and MetS and, in exploratory analyses restricted to participants with MetS, its components. The overall H. pylori positivity rate was 39.8%. The prevalence of MetS was significantly higher in the H. pylori -positive group than in the H. pylori -negative group (8.6% vs. 5.4%, P < 0.001). Among participants with MetS, the H. pylori -positive group was younger and had a markedly lower proportion of men than the H. pylori -negative group (43.3% vs. 92.9%; both P < 0.001). After adjustment for age and sex, H. pylori infection was associated with higher odds of MetS (OR = 1.85, 95% CI: 1.48–2.31; P < 0.001). Among patients with MetS, the prevalence of hyperglycemia was significantly higher in the H. pylori -negative group than in the H. pylori -positive group (37.6% vs. 22.5%, P = 0.002), whereas no significant differences were observed between the two groups in the prevalence of abdominal obesity, elevated blood pressure, or dyslipidemia (all P > 0.05). After adjustment for age, sex, and BMI, no statistically significant associations were observed between H. pylori infection and the individual metabolic components (all P > 0.05). Adjustment for age attenuated the estimate for hyperglycemia (OR changed from 0.48 to 0.63). Estimates for the other components changed little across models, although the confidence intervals were wide. H. pylori infection was associated with higher odds of MetS after adjustment for age and sex. In exploratory analyses restricted to participants with MetS, no statistically significant associations were observed with individual metabolic components. Given the cross-sectional design and the potential for residual confounding and selection bias, these findings do not establish temporality or causality. ClinicalTrials.gov, NCT07651202. Retrospectively registered on 11 June 2026.