Abstract
Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of chronic liver illness associated with obesity and metabolic disorders, such as hypertension, dyslipidemia, or type 2 diabetes mellitus. A more severe type of NAFLD, non-alcoholic steatohepatitis (NASH), is considered an ongoing global health threat and dramatically increases the risks of cirrhosis, liver failure, and hepatocellular carcinoma. Several reports have demonstrated that liver steatosis is associated with the elevation of certain clinical and biochemical markers but with low predictive potential. In addition, current imaging methods are inaccurate and inadequate for quantification of liver steatosis and do not distinguish clearly between the microvesicular and the macrovesicular types. On the other hand, an unhealthy status usually presents an altered gut microbiota, associated with the loss of its functions. Indeed, NAFLD pathophysiology has been linked to lower microbial diversity and a weakened intestinal barrier, exposing the host to bacterial components and stimulating pathways of immune defense and inflammation via toll-like receptor signaling. Moreover, this activation of inflammation in hepatocytes induces progression from simple steatosis to NASH. In the present review, we aim to: (a) summarize studies on both human and animals addressed to determine the impact of alterations in gut microbiota in NASH; (b) evaluate the potential role of such alterations as biomarkers for prognosis and diagnosis of this disorder; and (c) discuss the involvement of microbiota in the current treatment for NAFLD/NASH (i.e., bariatric surgery, physical exercise and lifestyle, diet, probiotics and prebiotics, and fecal microbiota transplantation).
Highlights
Non-alcoholic fatty liver disease (NAFLD), which is characterized by an increase in fat accumulation in the form of micro and macro vacuoles of lipids into hepatocytes, is the most common liver disorder worldwide [1]
Approximately 10% to 25% of people suffering NAFLD can progress to non-alcoholic steatohepatitis (NASH) [7], a more serious form of NAFLD which notably raises the possibilities of progression to cirrhosis and hepatocellular carcinoma (HCC)
The present review summarizes human and animal studies aimed to determine the impact of the gut microbiota alterations in NASH and their suitability as biomarkers for prognosis and diagnosis
Summary
Non-alcoholic fatty liver disease (NAFLD), which is characterized by an increase in fat accumulation in the form of micro and macro vacuoles of lipids into hepatocytes Current biomarkers for detecting, classifying, and tracking different features of NAFLD and NASH (namely, steatosis, necroinflammation, or fibrosis) present limitations due to their lack of accuracy, reproducibility, responsiveness, feasibility or economic cost This shows the need for more effective, less invasive, and more affordable methods for determining the extent of steatosis and its potential in progressing to a more severe status. All these challenges have increased the interest in developing novel methods for the diagnosis (biomarkers, gut microbiota, among others) and prediction of the different stages of NAFLD/NASH
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