Su1041 Non-Alcoholic Fatty Liver Disease (NAFLD) and Metabolic Syndrome Are Associated With Small Intestine Bacterial Overgrowth

Abstract

Background: Qualitative changes in gut bacteria have been shown to play a role in the development non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome. There is a lack of studies evaluating the association between small intestine bacterial overgrowth (SIBO) and NAFLD and metabolic syndrome. Aim: To evaluate the prevalence of NAFLD and metabolic syndrome in patients with SIBO and their relationship. Methods: In this case-control study, 372 eligible patients who had abdominal imaging and glucose hydrogen breath test in our institution from 2006 to 2014 were included. SIBO positive patients (the study group) were compared with those without SIBO (the control group). Clinical, demographic, laboratory variables and the presence of fatty liver on abdominal imaging were analyzed. Metabolic syndrome was defined as a minimum of 3/5 risk factors from The National Cholesterol Education Program's (NCEP) Adult Treatment Panel III report (ATP III). Results: Among the 372 patients, 141 (38%) had SIBO and 231 (62%) did not have SIBO. Patients with SIBO were more frequently being males (31.2% vs. 20.8%; p= 0.02), older in age (61.86±1.23 vs. 58.48 ±0.98 yrs; p=0.03), and having a higher frequency of low albumin (13.0% vs. 5.4%; p=0.009), hypertension (58.9% vs. 42.9%; p=0.002), diabetes mellitus (30.5% vs. 16.9%; p=0.002), NAFLD (33.3% vs. 20.8%; p=0.005), and metabolic syndrome (80.1% vs. 63.6%; p<0.000). Risk factors for NAFLD and/or metabolic syndrome were further evaluated. In the multivariable logistic regression analysis, SIBO remained as an independent risk factor for NAFLD along withmetabolic syndrome (p=0.038 and p<0.001, respectively). SIBO also remained as an independent risk factor for metabolic syndrome itself along with age above 60 years old and male gender (p=0.012, p<0.001 and p=0.036 respectively). Conclusion: SIBO is an independent risk factor for the development of both NAFLD and metabolic syndrome. These findings suggest that treatment of SIBO may benefit patients who concomitantly have NALFD and/or metabolic syndrome. The findings suggest a possible role of gut fermentation by bacterial overgrowth in the pathogenesis of NAFLD and metabolic syndrome. Furthermore, patients with SIBO should be routinely screened for NAFLD and metabolic syndrome and its consequences.