Association of worsening of nonalcoholic fatty liver disease with cardiometabolic function and intestinal bacterial overgrowth: A cross-sectional study

Marília Marques Pereira Lira,João Henrique Da Costa-Silva,Alexandre Sérgio Silva,Francisco Antônio De Oliveira Junior,Vinícius José Baccin Martins,José Eymard Moraes De Medeiros Filho,José Luiz De Brito Alves,Éder Jackson Bezerra De Almeida Filho,Gitana Da Silva,Oscar Millet

doi:10.1371/journal.pone.0237360

Abstract

Non-alcoholic fatty liver disease (NAFLD) has been associated with small bowel bacterial overgrowth (SIBO) and cardiometabolic dysfunction. This cross-sectional study aimed to evaluate the cardio-metabolic parameters and SIBO in patients with different degrees of hepatic fibrosis estimated by NAFLD fibrosis score (NFS). Subjects (n = 78) were allocated to three groups: Healthy control (n = 30), NAFLD with low risk of advanced fibrosis (NAFLD-LRAF, n = 17) and NAFLD with a high risk of advanced fibrosis (NAFLD-HRAF, n = 31). Anthropometrics, blood pressure, electrocardiogram and heart rate variability (HRV) were evaluated. Only the NAFLD-LRAF and NAFLD-HRAF groups were submitted to blood biochemical analysis and glucose hydrogen breath tests. The NAFLD-HRAF group had higher age and body mass index when compared to the control and NAFLD-LRAF groups. The prevalence of SIBO in the NAFLD group was 8.33%. The low frequency/high-frequency ratio (LF/HF ratio) was augmented in NAFLD-LRAF (p < 0.05) when compared with control group. NAFLD-HRAF group had a wide QRS complex (p < 0.05) and reduced LF/HF ratio (p < 0.05) compared to the control and NAFLD-LRAF groups. Serum levels of albumin and platelets were more reduced in the NAFLD-HRAF subjects (p < 0.05) than in the NAFLD-LRAF. NAFLD impairs cardiac autonomic function. Greater impairment was found in subjects with a worse degree of hepatic fibrosis estimated by NFS. Hypoalbuminemia and thrombocytopenia were higher in subjects with a worse degree of hepatic fibrosis, whereas prevalence of SIBO positive was similar between the groups.

Highlights

Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver diseases characterized mainly by macro-vesicular steatosis that occurs in the absence of alcoholic consumption
Greater impairment was found in subjects with a worse degree of hepatic fibrosis estimated by NAFLD fibrosis score (NFS)
Hypoalbuminemia and thrombocytopenia were higher in subjects with a worse degree of hepatic fibrosis, whereas prevalence of small intestinal bacterial overgrowth (SIBO) positive was similar between the groups

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver diseases characterized mainly by macro-vesicular steatosis that occurs in the absence of alcoholic consumption. The hepatic histology of patients with NAFLD varies from isolated hepatic steatosis to fatty liver with hepatocellular damage, inflammation and tissue fibrosis [1]. Some studies have reinforced the concept that small intestinal bacterial overgrowth (SIBO) plays an important role in the pathogenesis of NAFLD through endotoxin of bacteria and a tumor necrosis factor (TNF) as effective mediators [7,8]. Non-alcoholic fatty liver disease (NAFLD) has been associated with small bowel bacterial overgrowth (SIBO) and cardiometabolic dysfunction. This cross-sectional study aimed to evaluate the cardio-metabolic parameters and SIBO in patients with different degrees of hepatic fibrosis estimated by NAFLD fibrosis score (NFS)

Methods

Results

Conclusion