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- OPEN ACCESS
- Krishna K. Thakur,
- Crawford Revie,
- Henrik Stryhn,
- Shannon Scott Tibbetts,
- Jean Lavallée, and
- Raphaël Vanderstichel
Soft-shelled lobsters pose economic challenges to the lobster industry due to low meat yields and survivability during holding and transportation. Our objectives were to describe spatio-temporal patterns of soft-shelled lobsters in southwestern Nova Scotia, and identify environmental and lobster-related factors associated with shell quality. We analyzed data obtained from a broad-scale, intensive monitoring project and remotely sensed water temperatures. Mixed-effect logistic regression and linear regression methods analyzed more than 130 000 samples collected between 2004 and 2014. The annual overall prevalence of soft-shelled lobsters ranged from 9% to 38% and varied significantly among fishing areas. Shell quality was influenced by sex and size, and in the 2 months before the fishing season, lower water temperatures (4–6 weeks prior to sampling) were associated with reduced prevalence of soft-shells. High annual variability of soft-shell prevalence, that water temperature alone could not explain, suggests that adjusting fishing seasons, arbitrarily, in two fishing areas will not improve the overall shell quality of landed lobsters. Further research is needed to evaluate the effects of long-term temperature and ecosystem changes on lobster health in eastern Canada. - OPEN ACCESS
- Brett Emo,
- Li-Wen Hu,
- Bo-Yi Yang,
- Kahee A. Mohammed,
- Christian Geneus,
- Michael Vaughn,
- Zhengmin (Min) Qian, and
- Guang-Hui Dong
To assess the effects of housing characteristics and home environmental factors on lung function of Chinese children, 6740 children (aged 6–16 years) were recruited from seven cities in Northeast China in 2012. Performance of lung function was determined by comparison of forced vital capacity (FVC), forced expiratory volume (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF). Multivariate regression models were used to evaluate the associations with lung function deficit. The results showed that housing conditions were associated with lung function deficit in children. The adjusted odds ratios were 0.47 (95% CI: 0.26–0.83) for FVC for “ping-fang” housing compared with “dan-yuan-lou-fang” housing and 2.90 (95% CI: 2.43–3.47) for FEV1 with home renovations completed within two years compared with counterparts. The linear regression models consistently showed a significant association of housing conditions and home environmental factors with lung function measurements across subjects. A residence taller than seven stories was negatively associated with FEV1 (β = −55; 95% CI: −97 to −13). In conclusion, housing conditions and home environmental factors are particularly important to the development of lung function and respiratory health in children. These factors are concerning and action should be taken to improve them. - OPEN ACCESS
- Krishna K. Thakur,
- Raphaël Vanderstichel,
- Shaorong Li,
- Emilie Laurin,
- Strahan Tucker,
- Chrys Neville,
- Amy Tabata, and
- Kristina M. Miller
Infectious diseases are likely contributing to large-scale declines in chinook salmon stocks in the Pacific Northwest, but the specific agents and diseases involved, and the prevalences in migratory salmon, are mostly unknown. We applied a high-throughput microfluidics platform to screen for 45 infectious agents in 556 out-migrating juvenile chinook salmon, collected from freshwater (FW) and saltwater (SW) locations in the Cowichan River system on Vancouver Island, Canada, during 2014. Nineteen agents (5 bacterial, 2 viral, and 12 parasitic) were detected, with prevalences ranging from 0.2% to 57.6%. Co-infections between Candidatus Branchiomonas cysticola Toenshoff, Kvellestad, Mitchell, Steinum, Falk, Colquhoun & Horn, 2012, Paranucleospora theridion Nylund, Nylund, Watanabe, Arnesen & Kalrsbakk, 2010, and gill chlamydia, all associated with gill disease, were observed in SW samples. We detected agents known to cause large-scale mortalities in Pacific salmon (Ceratonova shasta (Noble, 1950), Parvicapsula minibicornis Kent, Whitaker & Dawe, 1977), and agents only recently reported in Pacific salmon in BC (Ca. B. cysticola, P. theridion, Facilispora margolisi Jones, Prosperi-Porta & Kim, 2012 and Parvicapsula pseudobranchicola Karlsbakk, Saether, Hostlund, Fjellsoy & Nylund, 2002). Wild and hatchery fish were most divergent in agent profiles in FW, with higher agent diversity in wild fish. Differences in prevalence largely dissipated once they converged in the marine environment, although hatchery fish may be infected by a greater diversity of agents sooner after ocean entry by virtue of their more rapid migration from nearshore to offshore environments. - OPEN ACCESSMercury (Hg) and polycyclic aromatic hydrocarbons (PAHs) are global pollutants known for their toxicity to wildlife. Because of their trophic position, common loons (Gavia immer (Brünnich 1764)) are excellent indicators of environmental quality. In 2014 and 2015, tissue samples of ten adult common loons (plus one recapture) were obtained in Meadow Lake Provincial Park, Saskatchewan, and assessed for Hg and PAH exposure. Blood and feather levels of these contaminants are indicative of exposure during breeding and in wintering areas, respectively. Compared with an international Hg database, blood Hg levels were low (<1 μg/g). In most loons (90.5%, 10 out of 11), blood PAH concentrations were also low (<10 ng/g), but high (120 ng/g) for one individual (9.5% 1 out of 11). Feather PAH concentrations were high (95.9 ng/g and 250.6 ng/g) in two of the four loons (50%) caught in 2015. These data indicate that loons breeding in Meadow Lake Provincial Park were exposed to low levels of Hg; however, some individuals are being exposed to PAHs in both their breeding and wintering locations. The effect of these environmental pollutants on individual loon fitness is unclear, but because of their extreme toxicity in biological systems we suggest that future monitoring in the surrounding region is warranted.
- OPEN ACCESSRanaviruses are emerging pathogens of poikilothermic vertebrates. In 2015 the Global Ranavirus Reporting System (GRRS) was established as a centralized, open access, online database for reports of the presence (and absence) of ranavirus around the globe. The GRRS has multiple data layers (e.g., location, date, host(s) species, and methods of detection) of use to those studying the epidemiology, ecology, and evolution of this group of viruses. Here we summarize the temporal, spatial, diagnostic, and host-taxonomic patterns of ranavirus reports in the GRRS. The number, distribution, and host diversity of ranavirus reports have increased dramatically since the mid 1990s, presumably in response to increased interest in ranaviruses and the conservation of their hosts, and also the availability of molecular diagnostics. Yet there are clear geographic and taxonomic biases among the reports. We encourage ranavirus researchers to add their studies to the portal because such collation can provide collaborative opportunities and unique insights to our developing knowledge of this pathogen and the emerging infectious disease that it causes.
- OPEN ACCESS
- Nicole A. Lopez Vargas,
- Laura Adamovicz,
- Brittany Willeford,
- Brian F. Allan, and
- Matthew C. Allender
Ranaviruses are worldwide pathogens of ectothermic vertebrates that can threaten herptile conservation efforts. Identifying transmission routes is critical for understanding disease ecology and promoting species conservation. Frog virus 3 (FV3) DNA was detected in mosquitoes during a ranavirus outbreak in semicaptive box turtles, but the role that insect vectors play under natural conditions is unknown. To address this knowledge gap, we collected mosquito species known to take blood meals from reptiles and amphibians (Aedes canadensis, Culex erraticus, Culex territans, and Uranotaenia sapphirina) from mid-May to early August, 2014, at four study sites in Vermilion County, Illinois, two of which had historic or ongoing FV3 outbreaks in box turtles and amphibians. Mosquitoes were batched by date and species, DNA was extracted, and quantitative polymerase chain reaction was performed for detection of FV3. FV3 was not detected despite one of the sites having an active FV3 outbreak during the study period. Our findings indicate that FV3 detection is uncommon in mosquitoes during outbreak and nonoutbreak conditions at these sites in Illinois. Thus, we cannot establish that mosquitoes contribute to transmission during natural mortality events without performing further studies. - OPEN ACCESSTo explore whether non-high-density-lipoprotein cholesterol (non-HDL-c) is associated with depression, a total of 26 819 Canadians aged 45–85 from the Canadian Longitudinal Study on Aging (CLSA) were included in analysis. Non-HDL-c, the difference between total-c and HDL-c, was categorized into five levels, i.e., <2.6, 2.6 to <3.7, 3.7 to <4.8, 4.8 to 5.7, and ≥5.7 mmol/L. History of clinical depression was collected by questionnaire at an in-home interview, and current potential depression status was determined by CES-D10 (Center for Epidemiological Studies Depression Scale 10 questions version) score, i.e., ≥10 vs. <10. Logistic continuation ratio model for ordinal data was used to estimate the odds of being at or above a higher non-HDL-c category for depression status. Compared with those without clinical depression history and currently undepressed, the adjusted odds ratios (95% CI) were 1.09 (1.02, 1.17) for those without clinical depression history but currently depressed, 1.05 (0.98, 1.12) for those had clinical depression history but currently undepressed, and 1.21 (1.10, 1.32) for those had clinical depression history and currently depressed. The average of non-HDL-c for four depression groups were 3.64, 3.71, 3.69, and 3.82 mmol/L, respectively, and group 4 was statistically higher than others (p < 0.001). In conclusion, people with both current depression and a history clinical depression are at an increased risk of having high level of non-HDL-c.
- OPEN ACCESS
- Martin Krkošek,
- Madeline Jarvis-Cross,
- Kiran Wadhawan,
- Isha Berry,
- Jean-Paul R. Soucy,
- Korryn Bodner,
- Ariel Greiner,
- Leila Krichel,
- Stephanie Penk,
- Dylan Shea,
- Juan S. Vargas Soto,
- Ed W. Tekwa,
- Nicole Mideo, and
- Péter K. Molnár
This study empirically quantifies dynamics of SARS-CoV-2 establishment and early spread in Canada. We developed a transmission model that was simulation tested and fitted in a Bayesian framework to timeseries of new cases per day prior to physical distancing interventions. A hierarchical version was fitted to all provinces simultaneously to obtain average estimates for Canada. Across scenarios of a latent period of 2–4 d and an infectious period of 5–9 d, the R0 estimate for Canada ranges from a minimum of 3.0 (95% CI: 2.3–3.9) to a maximum of 5.3 (95% CI: 3.9–7.1). Among provinces, the estimated commencement of community transmission ranged from 3 d before to 50 d after the first reported case and from 2 to 25 d before the first reports of community transmission. Among parameter scenarios and provinces, the median reduction in transmission needed to obtain R0 < 1 ranged from 46% (95% CI: 43%–48%) to 89% (95% CI: 88%–90%). Our results indicate that local epidemics of SARS-CoV-2 in Canada entail high levels of stochasticity, contagiousness, and observation delay, which facilitates rapid undetected spread and requires comprehensive testing and contact tracing for its containment. - OPEN ACCESS
- Stefan Baral,
- Andrew Bond,
- Andrew Boozary,
- Eva Bruketa,
- Nika Elmi,
- Deirdre Freiheit,
- S. Monty Ghosh,
- Marie Eve Goyer,
- Aaron M. Orkin,
- Jamie Patel,
- Tim Richter,
- Angela Robertson,
- Christy Sutherland,
- Tomislav Svoboda,
- Jeffrey Turnbull,
- Alexander Wong, and
- Alice Zhu
Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness. - OPEN ACCESSContact tracing has played a central role in COVID-19 control in many jurisdictions and is often used in conjunction with other measures such as travel restrictions and social distancing mandates. Contact tracing is made ineffective, however, by delays in testing, calling, and isolating. Even if delays are minimized, contact tracing triggered by testing of symptomatic individuals can only prevent a fraction of onward transmissions from contacts. Without other measures in place, contact tracing alone is insufficient to prevent exponential growth in the number of cases in a population with little immunity. Even when used effectively with other measures, occasional bursts in call loads can overwhelm contact tracing systems and lead to a loss of control. We propose embracing approaches to COVID-19 contact tracing that broadly test individuals without symptoms, in whatever way is economically feasible—either with fast and cheap tests that can be deployed widely, with pooled testing, or with screening of judiciously chosen groups of high-risk individuals. These considerations are important both in regions where widespread vaccination has been deployed and in those where few residents have been immunized.
- OPEN ACCESS
- Yannan Huang,
- Lindsay Johnston,
- Ana Parra,
- Crystal Sweeney,
- Emalie Hayes,
- Lisbeth Truelstrup Hansen,
- Graham Gagnon,
- Amina Stoddart, and
- Rob Jamieson
Wastewater-based surveillance methods have been implemented in several countries as a tool for monitoring SARS-CoV-2 at a community scale. A variety of methods have been used for concentrating, extracting, and detecting the virus, with no clear consensus on the most effective approach. In this note, we report preliminary findings from a study that is tracking SARS-CoV-2 in wastewater in Halifax, Nova Scotia, with a specific focus on the use of four reverse transcriptase quantitative PCR (RT-qPCR) assays for detecting the virus in wastewater. We were able to detect the virus in wastewater samples during the initial rise of cases in the Halifax region in early November 2020. Levels of the targeted SARS-CoV-2 gene fragments increased and fell in response to reported cases of COVID-19. The CDC N1 and E RT-qPCR assays demonstrated greater relative sensitivity than the CDC N2 and N3 assays for detection of SARS-CoV-2 in raw sewage samples. - OPEN ACCESSThis paper summarizes COVID-19 disease epidemiology in Canada in the pre-vaccine era—from January through to December 2020. Canadian case numbers, risk factors, disease presentations (including severe and critical disease), and outcomes are described. Differences between provinces and territories in geography, population size and density, health demographics, and pandemic impact are highlighted. Key concepts in public health response and mitigation are reviewed, including masking, physical distancing, hand washing, and the promotion of outdoor interactions. Adequate investment in public health infrastructure is stressed, and regional differences in screening and testing strategies are highlighted. The spread of COVID-19 in Canadian workplaces, long-term care homes, and schools is described and lessons learned emphasized. The impact of COVID-19 on vulnerable populations in Canada—including Indigenous Peoples, ethnic minorities and newcomers, people who use drugs, people who are homeless, people who are incarcerated, and people with disabilities—is described. Sex and gender disparities are also highlighted. Author recommendations include strategies to reduce transmission (such as test–trace–isolate), the establishment of nationally standardized definitions and public reporting, the protection of high risk and vulnerable populations, and the development of a national strategy on vaccine allocation.
- OPEN ACCESSThe Canadian federal Tri-Agency Research Data Management Policy has recently been released. This will require Canadian universities and other research institutes to create and share strategic plans regarding data management and to equip their researchers with skills to complete data deposits. To help maximize the success of data sharing we outline five domains for research institutions to consider during implementation: training and education, paying for data sharing, audit and feedback, meta-science, and career advancement.
- OPEN ACCESSCopeptin (C-terminal fragment of pro-arginine vasopressin) levels change as fasting plasma glucose (FPG) and blood pressure change. To explore the clinical significance of changes in copeptin levels in development of type 2 diabetes mellitus (T2DM), we enrolled patients undergoing physical health examinations who met diagnostic criteria for prediabetes and T2DM. Subjects were divided into eight subgroups based on FPG levels and presence or absence of hypertension, including: a normal group (NGT), FPG < 5.6 mmol/L; prediabetes A, 5.6 mmol/L ≤ FPG < 6.1 mmol/L; prediabetes B, 6.1 mmol/L ≤ FPG < 7.0 mmol/L; and T2DM, FPG ≥ 7.0 mmol/L; participants were further into two subgroups by whether they had hypertension or not. Measures included biochemical indicators, fasting insulin (FINS), and copeptin. Copeptin levels in prediabetes A, prediabetes B, and T2DM groups increased significantly compared to NGT group (P < 0.01). No significant differences were found in copeptin levels between normal blood pressure and hypertension subgroups in all four groups. Copeptin levels correlated positively with systolic blood pressure, glycosylated hemoglobin (HbA1c), FPG, FINS, and insulin resistance index (HOMA-IR; P < 0.05–0.001), and negatively with insulin secretion index (P < 0.05–0.001). Stepwise regression analysis revealed that copeptin levels correlated independently with elevated HbA1c and aggravated HOMA-IR (P < 0.001). Increase in copeptin levels may aggravate insulin resistance, finally leading to T2DM.
- OPEN ACCESS
- Eric Kai-Chung Wong,
- Jennifer Watt,
- Hanyan Zou,
- Arthana Chandraraj,
- Alissa Wenyue Zhang,
- Jahnel Brookes,
- Ashley Verduyn,
- Anna Berall,
- Richard Norman,
- Katrina Lynn Piggott,
- Terumi Izukawa,
- Sharon E. Straus, and
- Barbara Arlena Liu
Atypical disease presentations are common in older adults with COVID-19. The objective of this study was to determine the prevalence of atypical and typical symptoms in older adults with COVID-19 through progressive pandemic waves and the association of these symptoms with in-hospital mortality. This retrospective cohort study included consecutive adults aged over 65 years with confirmed COVID-19 infection who were admitted to seven hospitals in Toronto, Canada, from 1 March 2020 to 30 June 2021. The median age for the 1786 patients was 78.0 years and 847 (47.5%) were female. Atypical symptoms (as defined by geriatric syndromes) occurred in 1187 patients (66.5%), but rarely occurred in the absence of other symptoms (n = 106; 6.2%). The most common atypical symptoms were anorexia (n = 598; 33.5%), weakness (n = 519; 23.9%), and delirium (n = 449; 25.1%). Dyspnea (adjusted odds ratio [aOR] 2.05; 95% confidence interval [CI] 1.62–2.62), tachycardia (aOR 1.87; 95% CI 1.14–3.04), and delirium (aOR 1.52; 95% CI 1.18–1.96) were independently associated with in-hospital mortality. In a cohort of older adults hospitalized with COVID-19 infection, atypical presentations frequently overlapped with typical symptoms. Further research should be directed at understanding the cause and clinical significance of atypical presentations in older adults. - OPEN ACCESSSince the initial outbreak in December 2019, the COVID-19 pandemic has resulted in more than four million deaths worldwide. Ecuador initially experienced one of the worst coronavirus outbreaks in the world. The pandemic quickly overwhelmed health care systems resulting in excess deaths of 37 000 from March to October, 2020. The public health measures taken to stop the spread of the virus had a devastating impact on the economy. There was a sharp contraction (7.8%) in Ecuador’s GDP in 2020. Furthermore, income poverty and inequality increased dramatically. The lasting effects of the pandemic will be harder to overcome. This article recounts and analyzes the COVID-19 pandemic in Ecuador, to draw lessons from this complex experience, and from the benefit of limited but important successes. We also aim to provide suggestions for best practices moving forward.
- OPEN ACCESS
- Christine Fahim,
- Danielle Kasperavicius,
- Robyn Beckett,
- Keelia Quinn de Launay,
- Arthana Chandraraj,
- Amanda Crupi,
- Suvabna Theivendrampillai, and
- Sharon E. Straus
Knowledge translation (KT) is the science and practice of dissemination and implementation of evidence. We describe how research funders operationalize and evaluate KT initiatives, identify challenges and opportunities, and suggest strategic considerations for KT support. We conducted an environmental scan, which included a systematic search of published and grey literature and a focus group with Canadian funders. A total of 130 published articles and 2415 grey literature sources were screened; 212 unique data sources were included. Published literature commonly described KT initiatives related to “KT practice and science funding.” These initiatives commonly provided funds for infrastructure development (e.g., clinical technologies, database subscriptions) to facilitate translational or applied research to address regional health priorities. Of the articles, 44% outlined an evaluation plan; few provided validated KT metrics. In the grey literature, 364 initiatives were described; the most commonly described initiatives related to “exchange and integrated KT.” Focus group participants hoped to see increased resources to support KT, exchange opportunities with policy/decision-makers, and evaluate KT initiatives. Funders completed various KT initiatives, which tended to engage stakeholders to set research priorities, collaborate with a range of stakeholders, build KT capacity, and mandate KT requirements. We provide six considerations for funders to support KT. - OPEN ACCESSWildlife health surveillance is important in rapidly expanding urban areas, where wildlife live in close association with humans and face unique health risks. Urban areas are not homogeneous, and social and environmental factors may affect the distribution of surveillance data we receive from these environments. The Canadian Wildlife Health Cooperative (CWHC) operates a national wildlife surveillance programme that receives carcass submissions for diagnostic evaluation. Our objective was to evaluate sociodemographic and environmental factors associated with CWHC submissions within two cities in Ontario, Canada. Submissions were mapped at two geographic scales and linked with census and environmental data. The results of mixed multivariable Poisson and negative binomial regression analyses suggest that natural (e.g., percent parkland) and anthropogenic environmental (e.g., presence of a zoo) and social variables (e.g., low income) are associated with submissions at both administratively relevant scales. Associations that are common across scales may represent robust intervention points and inform surveillance methodology/messaging. Surveillance data may influence public health policy, wildlife management, and other decision-making regarding the benefits/risks associated with coexistence with wildlife. This study highlights gaps in surveillance methodology that may prevent equal opportunity for participation in wildlife health surveillance and enable equal opportunity to benefit from the associated outputs.
- OPEN ACCESSPiscine orthoreovirus genotype 1 (PRV-1) is a common virus in farmed and wild salmon in the northeastern Pacific Ocean. Its regional occurrence in freshwater is far less clear. From 2019 to 2021, tissues of 5619 juvenile anadromous salmon (primarily Atlantic, Chinook, and coho) sampled from 12 commercial and 27 enhancement British Columbia hatcheries during 83 sampling events were screened for PRV-1 prior to seawater entry. More than 2200 (∼40%) were also screened using a Pan-PRV assay targeting all known PRV genotypes. PRV-1 was detected in four coho salmon at two freshwater enhancement facilities and in one Chinook salmon at a commercial facility. Partial (S1 segment) genome sequencing identified detections to be of the PRV-1 subgenotype endemic to the northeastern Pacific. PRV-1 was not detected (5611 individuals; 99.9%) or test results were inconclusive (3 individuals; 0.05%) for all remaining samples screened for PRV-1. PRV-2 and PRV-3 were not detected using the Pan-PRV assay. It is concluded that commercial and enhancement freshwater hatcheries of British Columbia contribute minimally to the prevalence and persistence of PRV-1 in anadromous salmon of the northeastern Pacific, and these hatcheries appear not to have contracted or participated in the distribution of nonendemic forms of PRV in recent years.
- OPEN ACCESS
- Changxi Chen,
- Sha Si,
- Juan Du, and
- Hongliang Li
To investigate the epidemiological connection between nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (H. pylori). 6,478 retired and active workers, aged 22-69 years, were included in the study. Their baseline measures of height, weight, waist measurement, body mass index, blood pressure, fasting blood sugar, plasma lipid, liver function index, glycosylated hemoglobin, abdominal ultrasonography, and findings from the line “13 C urea breath test” H. pylori test were analyzed, and follow-up with consistent baseline methods and criteria was performed annually. Over a 4-year period, the prevalence of NAFLD increased by 16.9%, with 612 (18.7%) of those who tested positive for H. pylori developing NAFLD, whereas 484 (15.1%) of those who did not test positive for H. pylori were later diagnosed with new NAFLD (χ2 = 14.862, P < 0.05). One of the risk factors identified in the univariable Cox regression model for NAFLD was H. pylori (Hazard Ratio = 1.297; 95.0% confidence interval (CI) 1.150,1.485, P < 0.000); however, H. pylori continued to be an independent factor affecting the risk of NAFLD even after accounting for gender, age, and aspects of the metabolic syndrome (Hazard Ratio = 1.240; 95.0% CI 1.077,1.429, P = 0.003). The growth of NAFLD may be correlated with H. pylori infection.