Modification of the intestinal microbiota under the influence of combined treatment to prevent the progression of non-alcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a common disease with a steadily increasing incidence. Clinical and experimental studies of recent years testify to the key role of intestinal microbiota (IM) imbalance in the development and progression of NAFLD.
 Objective — to determine the effects of combined therapy on the state of the intestinal microbiota and to prevent the progression of NAFLD.
 Materials and methods. Investigation involved 108 patients NAFLD with metabolic disorders and 30 people of the control group, who were examined on the basis of the Department of Gastroenterology and Therapy, and out‑patient ward of the L. T. Malaya Therapy National Institute. Women prevailed in both investigated groups. The mean age of NAFLD patients was 54.6 ± 11.7 years. NAFLD patients were randomized into two comparable groups based on quantity, gender and age. Both groups received non‑drug therapy (correction of nutrition, increased physical activity). In addition, group I (60 patients) received ursodeoxycholic acid (UDCA) in a dose of 1000 mg, and probiotic preparation «Yogurt» capsules (2 billion active CFU cells) orally 1 capsule three times a day during meals. Comparison group II (48 patients) received only UDCA in a dose of 1000 mg. Treatment duration was 12 weeks. The patients were examined before and at the end of the treatment, with determination of the levels of main IM phyla, endotoxin, fetuin A. The dynamics of the degree of liver steatosis and fibrosis were also evaluated. Statistical processing was carried out using the package Statistica 13.1 using non‑parametric methods.
 Results. Additional administration of the probiotic drug resulted in the significant reduction of the Firmicutes quantity with simultaneous slight increase in the Bacteroidetes levels, but the changes did not reach the indicators of the control group. At the same time, the diversity of IM increased. The improvement of the IM balance was accompanied by a significant decrease of endotoxin level in patients with NAFLD who received combined therapy with the involvement of probiotic yogurt capsules. Under the influence of the developed treatment, a tendency to decrease the degree of liver steatosis and fibrosis was observed. In comparison group II, the dynamics of restoration of the liver tissue structure was less pronounced.
 Conclusions. The developed therapy positively contributed to improving the intestinal microbiota state, normalizing the functional state of the intestinal epithelial barrier, and reducing endotoxemia. The use of the developed complex therapy reduced the degree of fatty infiltration of hepatocytes and stopped the progression of liver fibrosis in the initial stages.