{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:41Z","timestamp":1789535081622,"version":"build-2803163510"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Although\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      (Hp) infection is a major global public health challenge, clinically applicable tools for individualized risk stratification remain limited, particularly in geographically diverse and high-altitude populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and internally validate a clinical prediction model for Hp infection using demographic, lifestyle, altitude-related, and clinical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This multicenter cross-sectional study included 2034 participants recruited from three medical institutions in Qinghai Province, China, between November 2025 and March 2026. Hp infection status was determined using the ^13C-urea breath test. Participants were randomly assigned to a training set (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091423) and a validation set (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009611). Candidate predictors associated with Hp infection in univariable logistic regression analysis (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05) were assessed for multicollinearity and subsequently entered into least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation. Predictors selected by LASSO were then included in a multivariable logistic regression model. A prediction model presented as a nomogram was subsequently developed. Model performance was assessed using receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven predictors were ultimately retained in the final model, including educational level, vegetable consumption, tooth brushing frequency, halitosis, family history of Hp infection, chronic gastritis, and high-altitude residence. The model demonstrated good discrimination, with area under the ROC curve (AUC) values of 0.774 in the training set and 0.756 in the validation set. Calibration analysis demonstrated good agreement between predicted and observed probabilities, with mean absolute errors of 0.018 and 0.037 in the training and validation sets, respectively. Decision curve analysis demonstrated consistent net clinical benefit in both sets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We developed and internally validated a prediction model for Hp infection incorporating seven readily obtainable variables. The model demonstrated satisfactory discrimination, calibration, and clinical utility and may facilitate individualized risk stratification and targeted screening strategies, particularly in high-altitude and geographically diverse populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1882621","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:33:20Z","timestamp":1789533200000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of a preliminary model for Helicobacter pylori infection: a cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Zihao","family":"Shen","sequence":"first","affiliation":[{"name":"Clinical Medical College, Qinghai University","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xixi","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingcheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xining No. 1 People\u2019s Hospital","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yincong","family":"Luo","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Qinghai University","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Li","sequence":"additional","affiliation":[{"name":"West China School of Medicine, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingjuan","family":"Du","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Qinghai University","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piao","family":"Yuan","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Qinghai University","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiqing","family":"Ye","sequence":"additional","affiliation":[{"name":"Clinical Medical College, Qinghai University","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yirong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Xining No. 1 People\u2019s Hospital","place":["Xining, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1053\/j.gastro.2017.04.022","article-title":"Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis","volume":"153","author":"Hooi","year":"2017","journal-title":"Gastroenterology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2404","DOI":"10.3390\/diagnostics13142404","article-title":"Helicobacter pylori (H. pylori) infection-associated Anemia in the Asir Region, Saudi Arabia","volume":"13","author":"Al Mutawa","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"222","DOI":"10.3390\/microorganisms12010222","article-title":"Helicobacter pylori: a contemporary perspective on pathogenesis, diagnosis and treatment strategies","volume":"12","author":"Ali","year":"2024","journal-title":"Microorganisms"},{"key":"B4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1038\/s41572-023-00431-8","article-title":"Helicobacter pylori infection","volume":"9","author":"Malfertheiner","year":"2023","journal-title":"Nat Rev Dis Primers"},{"key":"B5","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1002\/ijc.28999","article-title":"Global burden of gastric cancer attributable to Helicobacter pylori","volume":"136","author":"Plummer","year":"2015","journal-title":"Int J Cancer"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1703158","DOI":"10.3389\/fpubh.2025.1703158","article-title":"Social determinants of health and Helicobacter pylori infection prevalence: a systematic review and meta-analysis","volume":"13","author":"Wang","year":"2026","journal-title":"Front Public Health"},{"key":"B7","year":"2018"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e273","DOI":"10.1097\/mcg.0000000000001691","article-title":"Spatial-temporal distribution and influencing factors of Helicobacter pylori infection in Chinese mainland, 2001\u20132020: a systematic review and meta-analysis","volume":"56","author":"Lu","year":"2022","journal-title":"J Clin Gastroenterol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0155863","DOI":"10.1371\/journal.pone.0155863","article-title":"Comparative analysis of gut microbiota of native Tibetan and Han populations living at different altitudes","volume":"11","author":"Li","year":"2016","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2226","DOI":"10.3390\/nu15092226","article-title":"Association between dietary patterns and metabolic syndrome and modification effect of altitude: a cohort study of Tibetan adults in China","volume":"15","author":"Wang","year":"2023","journal-title":"Nutrients"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1055632","DOI":"10.3389\/fmicb.2022.1055632","article-title":"Review of the relationship and underlying mechanisms between the Qinghai-Tibet plateau and host intestinal flora","volume":"13","author":"Lv","year":"2022","journal-title":"Front Microbiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1136\/gutjnl-2022-327745","article-title":"Management of Helicobacter pylori infection: the Maastricht VI\/Florence consensus report","volume":"71","author":"Malfertheiner","year":"2022","journal-title":"Gut"},{"key":"B13","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1093\/ije\/31.3.638","article-title":"Helicobacter pylori infection in rural China: demographic, lifestyle and environmental factors","volume":"31","author":"Brown","year":"2002","journal-title":"Int J Epidemiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1186\/s12967-023-04398-8","article-title":"Association of dietary inflammatory index with Helicobacter pylori infection and mortality among US population","volume":"21","author":"Xiong","year":"2023","journal-title":"J Transl Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1186\/s12876-023-02990-2","article-title":"Lifestyle-based nomogram for identifying the Chaoshan inhabitants of China at high risk of Helicobacter pylori infection","volume":"23","author":"Lin","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1688708","DOI":"10.3389\/fpubh.2025.1688708","article-title":"Nine-year risk stratification and prediction of Helicobacter pylori infection using group-based trajectory modeling and machine learning in 35,206 adults","volume":"13","author":"Zhao","year":"2025","journal-title":"Front Public Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1111\/apt.14561","article-title":"Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection","volume":"47","author":"Zamani","year":"2018","journal-title":"Aliment Pharmacol Ther"},{"key":"B18","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1111\/j.1469-0691.2005.01189.x","article-title":"Prevalence and risk-factors for Helicobacter pylori infection in urban and rural Beninese populations","volume":"11","author":"Aguemon","year":"2005","journal-title":"Clin Microbiol Infect"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e54135","DOI":"10.2196\/54135","article-title":"Online health information seeking, eHealth literacy, and health behaviors among Chinese internet users: cross-sectional survey study","volume":"26","author":"Liu","year":"2024","journal-title":"J Med Internet Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e361","DOI":"10.1016\/s2468-2667(20)30144-4","article-title":"Education: a neglected social determinant of health","volume":"5","year":"2020","journal-title":"Lancet Public Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1136\/bmj.308.6931.750","article-title":"Relation between infection with Helicobacter pylori and living conditions in childhood: evidence for person to person transmission in early life","volume":"308","author":"Webb","year":"1994","journal-title":"Br Med J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/0140-6736(92)90931-r","article-title":"Childhood living conditions and Helicobacter pylori seropositivity in adult life","volume":"339","author":"Mendall","year":"1992","journal-title":"Lancet"},{"key":"B23","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1177\/2050640616642341","article-title":"Family history is an independent risk factor for the progression of gastric atrophy among patients with Helicobacter pylori infection","volume":"5","author":"Nishizawa","year":"2017","journal-title":"United European Gastroenterol J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"3706","DOI":"10.3748\/wjg.v28.i28.3706","article-title":"Family-based Helicobacter pylori infection status and transmission pattern in central China, and its clinical implications for related disease prevention","volume":"28","author":"Yu","year":"2022","journal-title":"World J Gastroenterol"},{"key":"B25","first-page":"131","article-title":"Detection of Helicobacter pylori colonization in dental plaques and tongue scrapings of patients with chronic gastritis","volume":"32","author":"Ozdemir","year":"2001","journal-title":"Quintessence Int"},{"key":"B26","doi-asserted-by":"publisher","first-page":"641","DOI":"10.3748\/wjg.v22.i2.641","article-title":"Helicobacter pylori colonization of the oral cavity: a milestone discovery","volume":"22","author":"Yee","year":"2016","journal-title":"World J Gastroenterol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1111\/j.1523-5378.2007.00471.x","article-title":"Oral health status and oral hygiene practices of patients with peptic ulcer and how these affect Helicobacter pylori eradication from the stomach","volume":"12","author":"Namiot","year":"2007","journal-title":"Helicobacter"},{"key":"B28","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1111\/j.1600-051X.2006.00915.x","article-title":"Persistence of Helicobacter pylori in the oral cavity after systemic eradication therapy","volume":"33","author":"Gebara","year":"2006","journal-title":"J Clin Periodontol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1111\/j.1600-0714.2010.00989.x","article-title":"The effectiveness of systemic eradication therapy against oral Helicobacter pylori","volume":"40","author":"Bago","year":"2011","journal-title":"J Oral Pathol Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2677","DOI":"10.1093\/molbev\/msab064","article-title":"High-altitude adaptation: mechanistic insights from integrated genomics and physiology","volume":"38","author":"Storz","year":"2021","journal-title":"Mol Biol Evol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1510932","DOI":"10.3389\/fgene.2024.1510932","article-title":"Genomic and physiological mechanisms of high-altitude adaptation in Ethiopian highlanders: a comparative perspective","volume":"15","author":"Seifu","year":"2025","journal-title":"Front Genet"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2557514","DOI":"10.1080\/07853890.2025.2557514","article-title":"The gut-kidney axis in high-altitude hypoxia: pathophysiological mechanisms and the central role of hypoxia inducible factor","volume":"57","author":"Wu","year":"2025","journal-title":"Ann Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"107615","DOI":"10.1016\/j.micpath.2025.107615","article-title":"Effect of hypoxia on the mucus system and intragastric microecology in the gastrointestinal tract","volume":"205","author":"Chen","year":"2025","journal-title":"Microb Pathog"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1007\/s00109-007-0277-z","article-title":"Hypoxia and gastrointestinal disease","volume":"85","author":"Taylor","year":"2007","journal-title":"J Mol Med (Berl)"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1070918","DOI":"10.3389\/fpubh.2022.1070918","article-title":"Disparities of obesity and non-communicable disease burden between the Tibetan plateau and developed megacities in China","volume":"10","author":"Peng","year":"2023","journal-title":"Front Public Health"},{"key":"B36","doi-asserted-by":"publisher","first-page":"2444","DOI":"10.3390\/nu13072444","article-title":"Food consumption and dietary patterns of local adults living on the Tibetan plateau: results from 14 countries along the Yarlung Tsangpo river","volume":"13","author":"Zhou","year":"2021","journal-title":"Nutrients"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1207710","DOI":"10.3389\/fnut.2023.1207710","article-title":"Lipid levels in the Jiarong Tibetan\u2019s diet at high altitudes: a cross-sectional survey","volume":"10","author":"Xiaoyue","year":"2023","journal-title":"Front Nutr"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e14113","DOI":"10.1097\/md.0000000000014113","article-title":"Dietary patterns and Helicobacter pylori infection in a group of Chinese adults ages between 45 and 59 years old: an observational study","volume":"98","author":"Shu","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"875","DOI":"10.3390\/pathogens10070875","article-title":"Impact of dietary patterns on H. pylori infection and the modulation of microbiota to counteract its effect. A narrative review","volume":"10","author":"Rueda-Robles","year":"2021","journal-title":"Pathogens"},{"key":"B40","doi-asserted-by":"publisher","first-page":"5019","DOI":"10.1002\/fsn3.4152","article-title":"Ultra-processed food intake and risk of Helicobacter pylori infection: a case-control study","volume":"12","author":"Ebrahimi","year":"2024","journal-title":"Food Sci Nutr"},{"key":"B41","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1016\/0046-8177(92)90132-m","article-title":"Pathologic changes of gastric mucosa colonized by Helicobacter pylori","volume":"23","author":"Hui","year":"1992","journal-title":"Hum Pathol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1221433","DOI":"10.3389\/fcimb.2023.1221433","article-title":"Helicobacter pylori infection altered gastric microbiota in patients with chronic gastritis","volume":"13","author":"Hua","year":"2023","journal-title":"Front Cell Infect Microbiol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"345","DOI":"10.4161\/gmic.28573","article-title":"The gastric microbial community, Helicobacter pylori colonization, and disease","volume":"5","author":"Martin","year":"2014","journal-title":"Gut Microbes"},{"key":"B44","doi-asserted-by":"publisher","first-page":"e70248","DOI":"10.1002\/puh2.70248","article-title":"Prevalence and predisposing factors of Helicobacter pylori infection in symptomatic patients: a multicenter study in Ghana\u2019s upper east region","volume":"5","author":"Awuni","year":"2026","journal-title":"Public Health Chall"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1753892","DOI":"10.3389\/fpubh.2026.1753892","article-title":"Seroprevalence and associated factors of Helicobacter pylori among Somali university students: a cross-sectional study","volume":"14","author":"Qudde","year":"2026","journal-title":"Front Public Health"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1882621\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:33:28Z","timestamp":1789533208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1882621\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":45,"alternative-id":["10.3389\/fmed.2026.1882621"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1882621","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"1882621"}}