Search Results (564)

Background/Objectives: Remnant cholesterol (remnant-C), derived from triglyceride-rich lipoproteins, is an important risk factor for cardiometabolic diseases. Given the metabolic link between dyslipidemia and skeletal muscle dysfunction, we aimed to evaluate the association between remnant-C and two key components of sarcopenia—low muscle mass and myosteatosis (ectopic fat deposition in skeletal muscle). Methods: This cross-sectional study included 11,570 patients who underwent abdominal computed tomography (CT) for health check-ups. Remnant-C was calculated as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. We conducted multivariable logistic and linear analyses to assess the association between remnant-C and low muscle mass, defined as appendicular skeletal muscle mass divided by body mass index. Additional analysis examined the relationship between remnant-C and myosteatosis, defined using the NAMA (normal attenuation muscle area) divided by TAMA (total abdominal muscle area) index, a novel index derived from muscle quality mapping of abdominal CT scans. Results: Low muscle mass was observed in 244 males (3.9%) and 74 females (1.4%). Myosteatosis affected 950 males (15.0%) and 800 females (15.3%). There was an increasing prevalence of both low muscle mass and myosteatosis across remnant-C quartiles. The multivariate-adjusted odds ratios (ORs) for low muscle mass in the highest remnant-C quartile compared with the lowest quartile were 2.17 (95% confidence interval [CI] 1.45–3.26) for males and 1.37 (95% CI 0.68–2.76) for females. The corresponding ORs for myosteatosis were 1.37 (95% CI 1.11–1.69) for males and 1.24 (95% CI 0.96–1.59) for females. Conclusions: Elevated remnant-C level is associated with low muscle mass and myosteatosis, especially in male patients. Individuals with higher remnant-C levels may warrant comprehensive evaluation for skeletal muscle health. Full article

Background/Objectives: Parenting interventions are an effective way to support child development, and brief screening tools can support equitable implementation of parenting interventions by reducing program costs, increasing accessibility, and engaging populations who have traditionally been underserved. However, brief assessments are frequently overlooked and underutilized. The Family Check-Up (FCU) Online is a digital parenting intervention that integrates a brief FCU Online Assessment, feedback, and parenting skills via an app along with optional provider support. To date, no prior work has validated the FCU Online Assessment. Method: The current study combined two samples of parents participating in FCU Online studies and assessed: (1) reliability, (2) construct validity, (3) convergent validity by comparing FCU Online Assessment subscales to similar parenting and child behavior measures, and (4) predictive validity by using FCU Online Assessment at pretest to predict posttest scores as well as parenting and child behaviors at time 2 and time 3. Results: Strong reliability was found among all five subscales, including Low Conflict (7 items, α = .81), Positive Parenting Practices (11 items, α = .80), Positive School Behaviors (5 items, α = .83), Consistent Rules and Routines (11 items, α = .81), and Child Mental Health (5 items, α = .80). The FCU Online Assessment demonstrated construct and convergent validity, as well as predictive validity in that the FCU Online Assessment at pretest predicted posttest scores. Conclusions: The FCU Online Assessment is a brief, reliable, and valid measure of parenting and child wellbeing. It can be used by parents and providers alike to evaluate parenting skills and child mental health, develop targeted goals and intervention approaches, and assess family wellbeing over time. Full article

Objective: We aimed to identify predictors of the transition to pre-frailty among older adults undergoing frailty health checkups and to evaluate their relative importance. Methods: A longitudinal analysis was conducted using data from a frailty health checkup project involving 830 older adults participating in community exercise classes in Matsumoto City, Nagano Prefecture, Japan. Among them, 502 individuals classified as robust (healthy) at baseline were followed for 1 year. Predictors of transition to pre-frailty were examined using multivariate logistic regression analysis. Given the low follow-up rate (43.4%), a sensitivity analysis using inverse probability weighting (IPW) was performed. Model performance was internally validated using bootstrap resampling and calibration assessment. Results: Of the 218 participants who completed the follow-up period, 45 (20.6%) transitioned to pre-frailty. Increasing age was a significant risk factor (OR = 1.13, 95% CI: 1.06–1.20), whereas higher health literacy was a protective factor (OR = 0.51, 95% CI: 0.29–0.86). In the IPW sensitivity analysis, the association with age remained stable, while health literacy demonstrated borderline significance (p = 0.08). The model showed acceptable discrimination (area under the curve [AUC] = 0.737; 0.728 after optimism correction) and good calibration (Hosmer–Lemeshow test, p = 0.124). Conclusions: Age and health literacy were independent predictors of transition to pre-frailty. As a modifiable factor, health literacy may represent a promising target for interventions aimed at preventing the progression to pre-frailty. Full article

Background/Aim: Routine ultrasonography now detects gallbladder polyps (GBPs) more often, but reported prevalence varies across populations. Jeju Island has South Korea’s highest obesity prevalence and red meat consumption, suggesting a rapid nutritional transition similar to that reported in Native Hawaiians. This study aimed to first analyze risk factors influencing GBP prevalence, including birthplace, and second compare clinical variables between JNs and JMs. Methods: Between May 2018 and October 2023, 28,751 individuals underwent medical checkups at Jeju National University Hospital. GBPs were diagnosed via ultrasonography, and risk factors including age, sex, birthplace, metabolic syndrome, hepatitis B virus antigen (HBsAg) positivity, lipid profiles, and alcohol consumption were assessed using univariate and multivariate logistic regression. Results: After exclusions, 15,219 participants were analyzed. The overall prevalence of GBPs was 10.3%. Male participants had a higher prevalence than females (11.4% vs. 9.1%, p < 0.001). The younger age group (20–49 years) showed the highest prevalence, while those aged ≥70 years had the lowest (11.6% vs. 8.6%, p = 0.001). Jeju Natives (JNs) exhibited a significantly higher prevalence than Jeju migrants (JMs) (10.6% vs. 9.0%, p = 0.004). Multivariate analysis identified female sex [odds ratio (OR) = 0.644, p < 0.001], age ≥ 70 years (OR = 0.601, p < 0.001), JN birthplace (OR = 1.260, p = 0.015), HBsAg positivity (OR = 1.347, p = 0.040), and high-risk alcohol drinking (OR = 0.758, p = 0.001) as independent predictors. Notably, the 60–69 age group did not reach statistical significance in the optimized model (p = 0.158). Compared to JMs, JNs were older and had a higher prevalence of fatty liver disease, a higher BMI, and higher levels of AST and GGT, but lower levels of HDL-cholesterol and triglycerides. Conclusions: GBPs are more prevalent among JNs compared to JMs, with birthplace emerging as a novel independent risk factor. Fatty liver disease, BMI, and reduced HDL-cholesterol were associated with GBP risk. These findings hypothesize that dietary and metabolic health factors may be potential pathways for the higher GBP prevalence among JNs, though direct dietary assessment is required for confirmation. Full article

Background: Underweight status is common among young women in Japan and has been linked to impaired glucose tolerance, but its long-term association with HbA1c trajectories remains unclear. This study examined whether body size history in the twenties is associated with subsequent HbA1c trajectories across adulthood. Methods: We analyzed health check-up data from Fujita Health University, collected between 2003 and 2025. Participants were classified as normal weight in the twenties (NW20s), underweight at least once in the twenties (UW20s_ever), or overweight at least once in the twenties (OW20s_ever), excluding mixed underweight/overweight histories. Eligible individuals had at least 5 years of follow-up, at least five BMI and HbA1c measurements, and at least one BMI record between ages 20 and 29 years. HbA1c trajectories were evaluated using sex-stratified linear mixed-effects models. Kaplan–Meier and Cox regression analyses were used to assess the risk of first reaching HbA1c ≥ 5.6%. Results: A total of 2923 participants were included in the trajectory analysis. For the time-to-event analysis, 2753 participants were included after exclusion of 170 participants with HbA1c ≥ 5.6% at study entry. Body size history in the twenties was associated with distinct, sex-specific HbA1c trajectories. OW20s_ever showed persistently higher HbA1c levels in both women and men, but the local slope of HbA1c was greater at ages 35 and 45 years in women and at age 25 years in men. In contrast, UW20s_ever showed lower HbA1c levels than NW20s at ages 25 and 35 years only in women. In complementary time-to-event analyses, OW20s_ever was associated with a higher risk of HbA1c ≥ 5.6% in both women and men (women: HR 1.37, 95% CI 1.06–1.76, p = 0.016; men: HR 1.81, 95% CI 1.41–2.32, p < 0.001), whereas UW20s_ever was associated with a lower risk only in women (HR 0.81, 95% CI 0.67–0.98, p = 0.028). Conclusions: Underweight and overweight history in the twenties are not simply mirror-image exposures but rather have sex-dependent and asymmetric associations with later HbA1c regulation. Full article

Purpose: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences in sociodemographic characteristics may exist between PRCDA and non-PRCDA counties, but have not been described; therefore, the potential selection bias associated with the restriction to PRCDA counties remains unknown. Methods: We used data from the University of California, San Francisco Health Atlas to explore ecological differences in county-level demographic, socioeconomic, healthcare access, and health outcomes data between PRCDA and non-PRCDA counties (n = 3152 counties). We tested for statistical differences in mean levels of demographics between PRCDA and non-PRCDA counties using Pooled or Welch t-tests. Results: We observed small, but statistically significant differences between PRCDA and non-PRCDA counties in county-level demographic and socioeconomic characteristics (age, poverty, utility services threat, unemployment, educational attainment, computer access, and median income), neighborhood and environment characteristics (overcrowding, severe mortgage/rent burden), healthcare access and utilization (uninsured, annual checkup, annual dental visit, mammography, binge drinking, smoking, physical inactivity, social isolation), and health outcomes (poor mental health, arthritis, poor self-rated health, high blood pressure, diabetes, high cholesterol, and obesity). Conclusions: These results indicate variability in county-level measures between PRCDA and non-PRCDA counties. While these data do not speak specifically to AIAN peoples’ experiences, they provide critical contextual information to understand how exclusion of AIAN people residing in non-PRCDA counties from cancer statistics may bias risk estimates. Full article

Background/Objectives: Neglect of children’s oral health is a major concern at international, national, and regional levels. Of all the health problems that can occur in childhood, dental ones are among the most common. Tooth decay, for example, is a chronic condition in children and can have long-term consequences, especially in otorhinolaryngology and pediatric diseases if not treated properly. Methods: The data collection method was questionnaire. Questionnaires were administered to parents regarding oral hygiene habits and access to dental services; data were collected in dental offices across Timiș County, encompassing urban, peri-urban, and rural settings. Children enrolled in the study underwent clinical dental examinations to assess their oral health status (dental caries, gingival diseases, developmental anomalies). Results: Parental education level was not significantly associated with the habit of annual dental check-ups (χ², p = 0.092); however, a directional trend was observed. Total monthly family income was significantly associated with the stated reason for not attending dental check-ups (one-way ANOVA, p = 0.043): families with lower incomes more frequently cited financial and logistical barriers, whereas higher-income families cited lack of time or perceived lack of necessity. Parental education level (p < 0.001) and family income (p < 0.001) were both significantly associated with daily tooth-brushing frequency. Conclusions: The efforts of specialists must be increased through coherent policies, adapted education, and real support for vulnerable groups. An informed child, with supported parents, is a child with a real chance at a healthy life. This is not just a professional opinion, but a collective responsibility. Full article

Objective: This study examined age- and sex-specific correlates of arterial stiffness, assessed by the cardio–ankle vascular index (CAVI), in apparently healthy Chinese adults using an anthropometric–metabolic–inflammatory framework, and descriptively compared subgroup association patterns across these domains. Methods: In this cross-sectional study, 525 apparently healthy Chinese adults aged 20–78 years were included. Regression models with age-by-indicator interaction terms were used to test whether the age–CAVI association varied across anthropometric, metabolic, and inflammatory indicators. Sex-adjusted analyses were applied to the overall sample, sex-stratified analyses were used to characterize sex-specific patterns, and the Benjamini–Hochberg false discovery rate correction was applied for multiple interaction tests. Results: CAVI increased progressively with age, with a steeper age–CAVI association after 50 years (p < 0.05). Notably, females showed a transient midlife elevation. Association patterns appeared to differ by sex. In the sex-stratified interaction analyses, anthropometric signals were more prominent in men, particularly for height (p < 0.01), whereas metabolic-related interaction signals were more evident in women, with triglycerides providing the clearest corresponding signal and low-density lipoprotein cholesterol (LDL-C) showing a weaker accompanying pattern; the C-reactive protein (CRP)-related contrast was not retained after additional adjustment for blood pressure and smoking. Conclusions: CAVI increased with age, with a steeper rise after midlife and a transient midlife elevation in women. The association patterns across anthropometric, metabolic, and inflammatory indicators appeared to differ by sex, with signals from the anthropometric domain appearing more evident in men and metabolic-related signals appearing more evident in women. These findings suggest that age- and sex-specific interpretation of CAVI may be informative in preventive health check-up settings. Full article

Background/Objectives: Functional dyspepsia (FD) is relatively common among young adults and is increasingly understood within the framework of brain–gut interactions. Eating behaviors and psychological distress may be related to FD, but evidence in young adults remains limited. This study examined the associations between FD and eating behaviors and depressive symptoms among university students. Methods: A cross-sectional study was conducted during health checkups. A total of 4328 students (2232 males and 2096 females) completed questionnaires assessing FD symptoms based on Rome IV, eating behaviors (EAT-26 and BITE), depressive symptoms (BDI-II), and coping styles (CISS). We compared scores between students with and without FD and performed multivariable logistic regression including gender, BMI, sleep, eating behaviors, and depressive symptoms. Results: The prevalence of questionnaire-based FD was 6.1% in males and 7.2% in females. Students with FD had higher EAT-26, BITE, BDI-II, and emotion-oriented coping scores. In multivariable logistic regression, EAT-26 ≥ 10 (OR: 1.92, 95% CI: 1.26–2.91, p = 0.002), BITE ≥ 10 (OR: 1.45, 95% CI: 1.01–2.08, p = 0.04), BDI-II ≥ 10 (OR: 3.83, 95% CI: 2.97–4.95, p < 0.001), and BMI < 18.5 kg/m² (OR: 1.74, 95% CI: 1.31–2.31, p < 0.001) were significantly associated with FD; gender and sleep were not. Conclusions: FD was associated with disordered eating behaviors, depressive symptoms, and low BMI. Differences in emotion-oriented coping were observed between groups. These findings suggest that integrating assessments of gastrointestinal symptoms, eating behaviors, and psychological factors may inform early detection and support at university. Full article

Smoking remains one of the leading preventable causes of chronic disease and premature workplace mortality worldwide. This study examined the association between smoking and nutritional status and hypertension and hematological disorders among hotel workers and occupational health nurses’ role in Indonesia. This cross-sectional study examined associations between smoking, nutritional status, and selected health outcomes among 366 hotel workers in Indonesia using routine medical check-up data. Logistic regression analyses were performed to assess the associations of smoking status and body mass index (BMI) categories with hypertension and hematological abnormalities (leukocytosis and anemia), after adjusting for age, gender, and job level. Older workers (40–69 years) and those categorized as overweight or obese had higher odds of hypertension than younger workers and those with normal BMI (ORs 2.63 and 1.37, respectively). Smoking was associated with a higher risk of leukocytosis (OR 0.395), reflecting increased risk among smokers due to variable coding. Older age and overweight status were strong predictors of hypertension, whereas smoking was associated with increased leukocytosis among hotel workers. These findings highlight the need for targeted OH interventions. Occupational health nurses should collaborate with management to strengthen WHP programs that encourage healthier lifestyles among employees. Full article

Aims: This study aimed to examine the associations between both birth weight (BW) and body mass index (BMI)/waist circumference (WC) measured at ages 7–10 years, and adolescent overweight (OW)/obesity (OB), and central OB at ages 11–13 years. Methods: Longitudinal data were collected from children’s and parents’ questionnaires. Anthropometric data were obtained from health check-ups. BW (kg) was categorized into three groups: <3.0, 3.0–3.9 and ≥4.0 (macrosomia). Underweight (UW)/normal weight (NW), OW and OB were defined based on sex- and age-specific reference values for Chinese children. Central OB was identified using the sex-specific waist-to-height ratio (WHtR) cutoffs. Results: Of the 1204 children, 14.5% had a BW < 3.0 and 15.6% had macrosomia. The rates of OB and central OB were 10.13% and 28.32%, respectively, among children aged 7–10 years and 6.23% and 23.34%, respectively, among those aged 11–13 years. An increasing BW z-score was associated with higher odds of OW/OB in girls aged 11–13 years. Childhood BMI and WC z-scores were associated with higher odds of OW/OB and central OB, respectively, at ages 11–13 years. Childhood OW/OB and central OB were associated with a higher risk of OW/OB and central OB, respectively, at ages 11–13 years. Conclusions: BW was modestly associated with OW/OB in girls. Childhood BMI was the strongest predictor of OW/OB, while childhood WC was a strong and significant predictor of central OB in early adolescence. These findings highlight that early school age is a critical period for risk identification and the implementation of future preventive strategies. Full article

Background: The real-world risk profiles of newly defined steatotic liver disease (SLD) subtypes—MASLD, MetALD, and ALD—remain incompletely described in community settings. Methods: A cross-sectional analysis of 950 health-checkup participants was conducted. SLD (CAP ≥ 248 dB/m) and significant fibrosis (LSM ≥ 7.0 kPa) were evaluated by transient elastography. Associations between alcohol intake, cardiometabolic factors, fibrosis, and gut microbiota (16S rRNA sequencing) were assessed. Results: Among 950 participants, 310 (33%) had SLD (MASLD, n = 222; MetALD, n = 41; ALD, n = 23). Treated as a continuous exposure, higher alcohol intake was significantly correlated with elevated systolic/diastolic blood pressure, triglycerides, AST, and γ-GTP, but inversely correlated with HOMA-IR (all p < 0.05). In multivariable logistic regression adjusting for cardiometabolic factors, BMI was the only independent predictor of fibrosis (adjusted OR 1.22, 95% CI 1.11–1.35, p < 0.01), whereas alcohol intake showed no independent association. Furthermore, microbiota analysis revealed that ALD-related SLD was characterized by significant depletion of Blautia and enrichment of Gemella (FDR q < 0.05) compared to non-SLD controls, indicating an alcohol-associated dysbiosis signature. Conclusions: In early-stage SLD, alcohol intake continuously exacerbates cardiometabolic risk factors, whereas fibrosis is predominantly driven by BMI. These findings support quantitative alcohol/BMI integration for risk stratification, alongside microbiota profiling to detect ALD-related dysbiosis. Full article

Background and Objectives: Postpartum depression (PPD) is a prevalent mental health condition with substantial consequences for mothers, infants, and families. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening instrument for PPD; however, optimal cut-off scores vary across populations, necessitating local validation. No prior study has evaluated the diagnostic performance of the EPDS against a structured clinical interview in Latvia. To assess the reliability and diagnostic accuracy of the Latvian version of the EPDS and to determine the optimal cut-off score for detecting PPD in a Latvian outpatient population 4–6 weeks after childbirth. Materials and Methods: A cross-sectional study was conducted at the outpatient department of Riga Maternity Hospital between June 2024 and May 2025. Women aged ≥18 years attending routine postnatal check-ups were screened using the Patient Health Questionnaire-9 (PHQ-9). Those scoring ≥5 were invited to complete the EPDS and participate in a structured diagnostic interview using the Mini International Neuropsychiatric Interview (MINI) 7.0.2. Internal consistency was assessed using Cronbach’s alpha. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic accuracy and identify the optimal cut-off score based on sensitivity, specificity, likelihood ratios, and the Youden Index. Results: A total of 272 women were screened, and 101 completed the EPDS; 78.63% of screen-positive participants underwent the MINI. The EPDS demonstrated excellent internal consistency (Cronbach’s α = 0.871). ROC analysis indicated strong discriminative ability (AUC = 0.852, 95% CI 0.759–0.945, p < 0.001). A cut-off score of ≥11 provided the optimal balance between sensitivity (0.74) and specificity (0.82), with the highest Youden Index (0.56) and a positive likelihood ratio of 4.14. Conclusions: The Latvian version of the EPDS is a reliable and diagnostically accurate screening instrument for PPD 4–6 weeks after delivery. A cut-off score of ≥11 appears optimal for routine screening in Latvian outpatient settings. These findings support the integration of EPDS-based screening into structured postpartum care and underscore the value of validating screening instruments within specific cultural and clinical contexts. Full article

Objectives: To clarify the characteristics of Basosquamous cell carcinoma (BSC), this study compares demographic, clinical, therapeutic, histological, and outcome findings of BSCs with those of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: The authors classified various definitions of BSC into three groups: the broadest, modest, and narrowest definitions. This study adopted the narrowest definition (both BCC and SCC features with transition zones in between) due to its wide use, its adoption by the World Health Organization, and the least heterogeneous definition. From 2009 to 2018, 20 consecutive cases of BSC presented in a single institution, along with 130 cases of BCC and 81 cases of SCC. Results: The statistically different parameters of BSC compared to BCC or SCC were age (SCC > BSC, BCC), duration (BSC, BCC > SCC), unclear border (BSC > BCC, SCC), higher NCCN classification (BSC, SCC > BCC), safety margin (SCC > BSC > BCC), operation time (BSC, SCC > BCC), reconstruction (less primary closure in BSC than BCC), microscopic size (BSC, SCC > BCC), perineural invasion (BSC > BCC), free lateral margin (BSC, SCC > BCC), and follow-up period (BSC > BCC, SCC). Regarding outcome, one distant metastasis (6.3%) in BSCs, no aggressive consequences in BCCs, and four local recurrences (11.1%), two lymph node metastases (5.6%), and one distant metastasis (2.7%) in SCCs were observed. Conclusions: In this Asian cohort, BSC has a trend toward higher rates of overall adverse outcomes compared to BCC, although this difference did not reach definitive statistical significance, unlike the findings reported in Caucasian populations. Early detection and appropriate treatment at the individual patient level are warranted to minimize rare but clinically relevant adverse events and reproduce favorable outcomes at the population level. Wide local excision followed by local flaps could be a successful surgical option with an adequate safety margin and double histopathologic intraoperative and postoperative check-up. Full article

Background: Hepatitis B virus (HBV) is an infection proven to increase the risk of gastric cancer, especially among hepatitis B virus surface antigen (HBsAg) seropositive patients. However, the route through which HBV injures gastric mucosa and its mechanism of gastric carcinogenesis are still under investigation. Aims: The present study aimed to observe and evaluate associations between HBV infection with Helicobacter pylori, atrophic gastritis, and some other high-risk events for gastric cancer development. Methods: A retrospective cross-sectional study recruited participants undergoing a health check-up between 2018 and 2020 in the West China Hospital of Sichuan University. Participants were stratified into three statuses, including Group A (non-HBV infection), Group B (resolved HBV infection), and Group C (chronic HBsAg carriers or active HBV infection). Additionally, Groups A and B were categorized as HBsAg-seronegative, whereas Group C was defined as HBsAg-seropositive. High-risk events of gastric cancer included a history of gastric ulcer, Helicobacter pylori infection, serological atrophic gastritis (serum pepsinogens), hypergastrinemia (serum gastrin-17), and endoscopic findings of atrophic gastritis, gastric polyps, and gastric ulcer. Associations of HBV infection status or HBsAg seropositivity with Helicobacter pylori infection, atrophic gastritis and other high-risk events of gastric cancer were analyzed. Results: A total of 21,505 eligible observations were included, with Group C accounting for 6.1%. In Group C, the prevalence of gastric ulcer (p = 0.002) and very-high serum gastrin-17 level (p = 0.002) was significantly greater than in Group A. In multivariate analysis, both Helicobacter pylori infection (aOR = 2.79, 95% CI 2.44–3.21) and HBsAg seropositivity (aOR = 1.28, 95% CI 1.02–1.59) were significant risk factors for hypergastrinemia. No interaction was found between Helicobacter pylori co-infection risks and Group B (aOR = 1.10, 95% CI 0.84–1.43) or Group C (aOR = 1.40, 95% CI 0.66–2.95). Helicobacter pylori infection was identified as an independent risk factor for atrophic gastritis (aOR = 1.85, 95% CI 1.44–2.39). However, HBsAg seropositivity did not show a similar association with atrophic gastritis (aOR = 1.15, 95% CI 0.75–1.74). Moreover, HBV co-infection did not exert a synergistic effect on the risk of atrophic gastritis in individuals with Helicobacter pylori (aOR = 1.09, 95% CI 0.54–2.22). Additionally, multivariate analyses did not identify significant associations between HBV infection statuses and gastric polyps or ulcers. Conclusions: HBsAg seropositivity was not associated with increased risk of atrophic gastritis, gastric polyps or ulcers, or Helicobacter pylori infection, with the exception of hypergastrinemia. Additionally, HBV co-infection did not exert a synergistic effect on increasing the risk of atrophic gastritis in patients with Helicobacter pylori. Collectively, these findings suggest that the mechanism underlying the increased risk of gastric cancer in individuals with HBV may not be predominantly mediated via Helicobacter pylori infection and atrophic gastritis. Theories regarding HBV-induced genotoxicity or confounding effects warrant further investigation. Full article