**1. Introduction**

*Helicobacter pylori* (*H. pylori*) is a Gram-negative spiral-shaped bacterium, which colonizes and grows in human gastric epithelial tissue and mucosa [1]. More than 50% of the global population are infected by *H. pylori* especially in developing countries and among populations with low socioeconomic status [2]. *H. pylori* is usually transmitted through the feco-oral route due to ingestion of contaminated water or food, but it can be transmitted through direct contact with saliva and vomitus [3,4]. The microorganism was classified as a group 1 carcinogen [5] and it causes various upper gastrointestinal (GI) disorders including

**Citation:** Habbash, F.; Alalwan, T.A.; Perna, S.; Ahmed, N.; Sharif, O.; Al Sayyad, A.; Gasparri, C.; Ferraris, C.; Rondanelli, M. Association between Dietary Habits and *Helicobacter pylori* Infection among Bahraini Adults. *Nutrients* **2022**, *14*, 4215. https:// doi.org/10.3390/nu14194215

Academic Editors: Omorogieva Ojo and Amanda R Amorim Adegboye

Received: 12 September 2022 Accepted: 30 September 2022 Published: 10 October 2022

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gastritis, gastroduodenal ulcer diseases, and gastric adenocarcinoma [6]. The latter was recognized to be the fourth-leading cause of cancer-related deaths worldwide in 2020 [7].

Acquisition and various disease outcomes of *H. pylori* infection are intermediated by complex interactions between bacterial virulence, host, and environmental factors [8]. There is a high level of disparity in *H. pylori* genetic recombination and these genetic differences might exist even in *H. pylori* colonizing the same individual [9]. Host genetic background might contribute to protection from infection with *H. pylori* infection [9]. Some factors associated with *H. pylori* infection include age, gender, ethnicity, educational level, and household income [10]. Furthermore, the crowding index, living standards which include sanitation and hygiene, and the source of drinking water have all been shown to be associated with H. *pylori* infection [11]. Findings related to the relationship between smoking and *H. pylori* infection in previous studies are conflicting [12–15].

Over the past years, epidemiological studies have found that diet plays a significant role in the development of *H. pylori* infection and investigated the association between the intake of certain foods and nutrients and the development of such infection [16–18]. Some studies have reported that salty, pickled, fermented, or smoked foods increased the risk of *H. pylori* infection [19,20]. On the other hand, other studies have shown that antioxidant-rich fruits and vegetables were protective against *H. pylori* infection [21–23]. Moreover, it was reported that lower intakes of raw vegetables were significantly associated with a higher risk of *H. pylori* infection [17]. Similarly, meat consumption and consumption of restaurant food were associated in some studies with an increased risk of *H. pylori* infection, while chili pepper intake was shown to have a protective effect [12,17]. In addition, some studies revealed a protective effect of honey and green tea consumption against *H. pylori* infection [24–26]. Coffee consumption has been linked to several health benefits and some studies found an inverse association between coffee consumption and the systemic levels of some inflammatory markers [27]. However, it was reported that frequent consumption of coffee was associated with an increased rate of *H. pylori* infection and exacerbation of *H. pylori*-related gastritis symptoms [18,28]. Some studies did not find any association between coffee consumption and *H. pylori* infection [10,29,30]. In addition, the relationship between *H. pylori* infection and several modifiable cardio-metabolic risk factors was reported in the literature [31–33].

Risk factors associated with *H. pylori* infection, especially lifestyle and dietary habits, have not been investigated thoroughly in the Kingdom of Bahrain. Given the high burden of *H. pylori* infection in developing countries and the high prevalence of modifiable cardiometabolic risk factors in the Middle East and North Africa (MENA) region, including the Kingdom of Bahrain, a study investigating the relationship between predisposing factors to *H. pylori* infection including dietary habits is warranted. This study aims to provide preliminary data regarding *H. pylori* infection prevalence and predisposing factors among a group of Bahraini adults followed in the Gastroenterology (GE) unit in a tertiary care hospital. The findings of this study will help in the future planning of appropriate preventive, diagnostic, and treatment strategies for *H. pylori* infection.

#### **2. Materials and Methods**

#### *2.1. Study Design, Setting and Duration*

This hospital-based retrospective cross-sectional, analytical study was conducted in the Gastroenterology unit in King Hamad University Hospital (KHUH) in the Kingdom of Bahrain between the period of January and September 2021. It combines data from medical records for *H. pylori* status, other comorbidities, and biochemical parameters with sociodemographic, lifestyle, and dietary habits information using a tele-interview.
