Gut Microbiota in Non-Alcoholic Fatty Liver Disease Patients with Inflammatory Bowel Diseases: A Complex Interplay

Abenavoli, Ludovico; Giubilei, L.; Procopio, Anna; Spagnuolo, Rocco; Luzza, Francesco; Boccuto, Luigi; Scarpellini, Emidio

doi:10.3390/nu14245323

Cited by 21 publications

(19 citation statements)

References 58 publications

(60 reference statements)

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“…The microbiota of the intestines encompasses the microbial community inhabiting the GI tract, with an estimated presence of more than 100 trillion microorganisms 29. Colonisation begins at birth, matures over time, and is affected by various dietary, environmental, and genetic factors 30. In a healthy patient, the host and bacterial colonisers within the microbiota display a delicate symbiotic homeostasis.…”

Section: Discussionmentioning

confidence: 99%

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Association of metabolic dysfunction-associated fatty liver disease with gastrointestinal infections: insights from National Inpatient Sample Database

Patel,

Sohal,

Bains

et al. 2024

BMJ Open Gastroenterol

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ObjectivesThe study aimed to compare the risk of gastrointestinal infections among patients with and without metabolic dysfunction-associated fatty liver disease (MAFLD).MethodsThis was a population-based, retrospective, observational study using data from the National Inpatient Sample (NIS), the largest all-payer US inpatient care database.SettingHospitalisation of adults aged ≥18 years old admitted in 2020 was identified using the NIS. Patients were stratified by the presence and absence of MAFLD.Participants26.4 million adults aged ≥18 years old were included in the study. Patients younger than 18 and those with missing demographic or mortality data were excluded.Primary and secondary outcomesPrimary outcome was to assess the overall risk of gastrointestinal infections in patients with and without MAFLD. Secondary outcomes were demographics and comorbidities stratified by the presence or absence of gastrointestinal infection, and the risk of specific gastrointestinal pathogens.ResultsOf 26.4 million patients admitted in 2020, 755 910 (2.85%) had the presence of MAFLD. There was a higher prevalence of bacterial gastrointestinal infections in patients with MAFLD than those without (1.6% vs 0.9%, p<0.001). The incidence ofClostridioides difficile(1.3% vs 0.8%, p<0.001),Escherichia coli(0.3% vs 0.01%, p<0.001), andSalmonella(0.07% vs 0.03%, p<0.001) was higher in patients with MAFLD. The presence of MAFLD was associated with higher odds of developing gastrointestinal infections (adjusted OR (aOR) −1.75, 95% CI −1.68 to 1.83, p<0.001). After adjusting for confounders, results remained statistically significant (aOR −1.36, 95% CI - 1.30-1.42, p<0.001).ConclusionEven after adjusting for confounding factors, our study demonstrates an increased risk of gastrointestinal infections in patients with MAFLD, specifically ofC. difficile,E. coli, andSalmonella. The immune and microbiota changes seen within MAFLD potentially contribute to the increased risk of gastrointestinal infections.

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Section: Discussionmentioning

confidence: 99%

“…Changes in the microbiota have also been noted in patients with MAFLD. The gut microbiome’s main intestinal phyla are Firmicutes and Bacteroidetes , which amass more than 90% of the entire microorganism population 30. A disruption in population sizes and ratios may contribute to the pathological effects seen in MAFLD.…”

Section: Discussionmentioning

confidence: 99%

Association of metabolic dysfunction-associated fatty liver disease with gastrointestinal infections: insights from National Inpatient Sample Database

Patel,

Sohal,

Bains

et al. 2024

BMJ Open Gastroenterol

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“…The study by Abenavoli et al (2022) aimed to shed light on the complex interplay between gut microbiota and two increasingly prevalent diseases, NAFLD and IBD [9]. It is worth mentioning that NAFLD encompasses a range of conditions, ranging from simple fatty liver to NASH, which can eventually lead to liver cirrhosis and hepatocellular carcinoma [10].…”

Section: Discussionmentioning

confidence: 99%

“…Despite numerous studies supporting a positive association between IBD and NAFLD, a clear and well-established common pathogenesis has yet to be determined, although several emerging hypotheses exist [15]. In effect, they point to a potential interplay between factors such as increased intestinal permeability, changes in gut microbiota, endotoxemia, oxidative stress-induced inflammation, and genetic susceptibility [9,16]. Herein, the overproduction of conjugated bile acids due to gut dysbiosis may contribute to the development of NAFLD when they are returned to the liver [17].…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Non-Alcoholic Steatohepatitis in Patients With Inflammatory Bowel Disease: A Population-Based Study

Onwuzo¹,

Boustany²,

Saleh³

et al. 2023

Cureus

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Background and objectiveThe global health burden of inflammatory bowel disease (IBD) stems from its increasing incidence over the years. Comprehensive studies on the topic hypothesize that IBD plays a more dominant in the development of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In light of this, we conducted this study with the aim of assessing the prevalence and risk factors of developing NASH in patients who have had a diagnosis of ulcerative colitis (UC) and Crohn's disease (CD). MethodologyA validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States from 1999 to September 2022 was utilized for conducting this study. Patients aged 18-65 years were included. Pregnant patients and individuals diagnosed with alcohol use disorder were excluded. The risk of developing NASH was calculated using a multivariate regression analysis to account for potential confounding variables including male gender, hyperlipidemia, hypertension, type 2 diabetes mellitus (T2DM), and obesity. A two-sided p-value <0.05 was considered statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008). ResultsA total of 79,346,259 individuals were screened in the database and 46,667,720 were selected for the final analysis based on the inclusion and exclusion criteria. Using multivariate regression analysis, the risk of developing NASH among patients with UC and CD was calculated. The odds of having NASH among patients with UC was 2.37 (95% CI: 2.17-2.60, p<0.001). Similarly, the odds of having NASH were high in patients with CD as well, at 2.79 (95% CI: 2.58-3.02, p<0.001). ConclusionBased on our findings, patients with IBD have an increased prevalence and higher odds of developing NASH after controlling for common risk factors. We believe that a complex pathophysiological relationship exists between both disease processes. Further research is required to establish appropriate screening times to enable earlier disease identification and thereby improve patient outcomes.

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“…Although the pathogenetic link between gut microbiota and NAFLD has been widely investigated [ 27 , 28 ], its relationship with MAFLD is poorly known. It is well known that MAFLD is a “multiple-hit” disease, which has obesity, diabetes, insulin resistance, genetic and environmental factors, and a dysbiosis of the gut microbiota as risk factors [ 29 ], as shown in Figure 3 .…”

Section: Mafld and Gut Microbiota: Possible Pathogenetic Waysmentioning

confidence: 99%

Metabolic-Dysfunction-Associated Fatty Liver Disease and Gut Microbiota: From Fatty Liver to Dysmetabolic Syndrome

et al. 2023

Self Cite

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Metabolic-dysfunction-associated fatty liver disease (MAFLD) is the recent nomenclature designation that associates the condition of non-alcoholic fatty liver disease (NAFLD) with metabolic dysfunction. Its diagnosis has been debated in the recent period and is generally associated with a diagnosis of steatosis and at least one pathologic condition among overweight/obesity, type 2 diabetes mellitus, and metabolic dysregulation. Its pathogenesis is defined by a “multiple-hit” model and is associated with alteration or dysbiosis of the gut microbiota. The pathogenic role of dysbiosis of the gut microbiota has been investigated in many diseases, including obesity, type 2 diabetes mellitus, and NAFLD. However, only a few works correlate it with MAFLD, although common pathogenetic links to these diseases are suspected. This review underlines the most recurrent changes in the gut microbiota of patients with MAFLD, while also evidencing possible pathogenetic links.

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Gut Microbiota in Non-Alcoholic Fatty Liver Disease Patients with Inflammatory Bowel Diseases: A Complex Interplay

Cited by 21 publications

References 58 publications

Association of metabolic dysfunction-associated fatty liver disease with gastrointestinal infections: insights from National Inpatient Sample Database

Association of metabolic dysfunction-associated fatty liver disease with gastrointestinal infections: insights from National Inpatient Sample Database

Increased Risk of Non-Alcoholic Steatohepatitis in Patients With Inflammatory Bowel Disease: A Population-Based Study

Metabolic-Dysfunction-Associated Fatty Liver Disease and Gut Microbiota: From Fatty Liver to Dysmetabolic Syndrome

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