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Some studies suggest a possible link between the two conditions. The purpose of this study is to study the relationship between <jats:italic>H. pylori<\/jats:italic> infection and NAFLD in pediatrics and its relation to NAFLD grades. A case\u2013control study to identify predictors of NAFLD and a comparative cross-sectional approach to determine factors affecting NAFLD grades were adopted. One hundred NAFLD children (ultrasound-based) and a control group of 100 non-NAFLD children were recruited. Both groups were evaluated by detecting <jats:italic>H. pylori<\/jats:italic> stool antigen. Immunoglobulin G antibodies to Cag A (cytotoxin-associated gene A), Vac A (vacuolating\u00a0cytotoxin A), Gro EL (chaperonin Gro EL), HCPC (Helicobacter\u00a0cysteine-rich protein C), and Ure A (Urease subunit A) were assessed in the serum of those with positive stool antigen. <jats:italic>H. pylori<\/jats:italic> infection was significantly higher in NAFLD children compared to the control group (64% versus 25%, <jats:italic>p<\/jats:italic>-value\u2009&lt;\u2009.001).\u00a0(NAFLD children showed higher Cag A and Vac A positivity (34, 10%) versus (2%, 0%) in the control group, respectively, <jats:italic>p<\/jats:italic>-value &lt; .001). The regression model showed that <jats:italic>H. pylori<\/jats:italic> positivity (OR (odds ratio)\u2009=\u20095.021, 95% CI (confidence interval): 1.105\u201322.815), homeostatic model assessment of insulin resistance (Homa IR) (OR\u2009=\u200918.840, 95% CI: 3.998\u201388.789), waist percentile (OR\u2009=\u20091.184, 95% CI: 1.044\u20131.344), and triglycerides (OR\u2009=\u20091.029, 95% CI: 1.012\u20131.047) were predictors for NAFLD. Cag A positivity (OR\u2009=\u20092.740, 95% CI: 1.013\u20137.411) was associated with higher NAFLD grade (grade 2 fatty liver).<\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions:<\/jats:italic>\n            <jats:italic>H. pylori<\/jats:italic> infection could increase the risk of NAFLD in children. Triglycerides, waist circumference, and Homa IR are significant independent predictors of NAFLD.\n<jats:table-wrap>\n              <jats:table>\n                <jats:tbody>\n                  <jats:tr>\n                    <jats:td align=\"left\">\n                      <jats:bold>What is Known:<\/jats:bold>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\u2022\u00a0<jats:italic>NAFLD has become one of the most common liver diseases among children because of the increased\u00a0<\/jats:italic>\n                      <jats:italic>prevalence of pediatric obesity.<\/jats:italic>\u2022\u00a0<jats:italic>Dyslipidemia and insulin resistance play a central role in NAFLD pathogenesis.<\/jats:italic> \u2022\u00a0<jats:italic>NAFLD could be explained by the multiple-hit hypothesis. The gut microbiota is an important factor in this\u00a0hypothesis (gut liver axis).<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\n                      <jats:bold>What is New:<\/jats:bold>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\u2022\u00a0<jats:italic>Helicobacter pylori infection could increase the risk of NAFLD in children.<\/jats:italic> \u2022\u00a0<jats:italic>H. pylori Cytotoxin-associated gene A (Cag A) positivity is associated with higher NAFLD grade.<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                <\/jats:tbody>\n              <\/jats:table>\n            <\/jats:table-wrap>\n          <\/jats:p>","DOI":"10.1007\/s00431-024-05867-y","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T11:09:13Z","timestamp":1732705753000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Is Helicobacter pylori infection a risk factor for non-alcoholic fatty liver disease in children?"],"prefix":"10.1007","volume":"184","author":[{"given":"Sana","family":"Barakat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abdel-Fadeel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Sharaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed El","family":"Shafei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8493-9309","authenticated-orcid":false,"given":"Basant","family":"Elbanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aml","family":"Mahfouz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"key":"5867_CR1","doi-asserted-by":"publisher","first-page":"8078","DOI":"10.3748\/wjg.v22.i36.8078","volume":"22","author":"MG Clemente","year":"2016","unstructured":"Clemente MG, Mandato C, Poeta M et al (2016) Pediatric non-alcoholic fatty liver disease: recent solutions, unresolved issues, and future research directions. 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