Modulation of the gut microbiota represents a new management for non-alcoholic fatty liver disease

Bakhshimoghaddam, F and Alizadeh, M (2019) Modulation of the gut microbiota represents a new management for non-alcoholic fatty liver disease. HepatoBiliary Surgery and Nutrition. pp. 1-4.

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Abstract

With the worldwide spread of diet westernization, sedentary lifestyle, and obesity, non-alcoholic fatty liver disease (NAFLD) has becoming frequent disorder. NAFLD is the presence of hepatic fat infiltration more than 5% of liver cells, in lack of alcohol abuse or steatogenic drugs. NAFLD includes a spectrum of liver disorder, ranging from steatosis and non-alcoholic steatohepatitis (NASH) to fibrosis, cirrhosis and hepatocellular carcinoma (1). Metabolic syndrome and systemic micro-inflammation are the most relevant metabolic disorders related to this spectrum of diseases (2). There is currently no approved pharmacological treatment for NAFLD. The management strategy of NAFLD involves lifestyle interventions, including diet, exercise, and behavior modification (1). The intestinal microbiota has been a topic of scientific research for a recent decade. The gut microbiota composed of organized community of microorganisms (3). The literature to date suggests points to a critical impact of the intestinal flora and intestinal barrier on the pathogenesis of NAFLD and other metabolic disorders (4). Dysbiosis, which is defined as changes in intestinal bacteria, and small intestine bacterial overgrowth, which is related to dietary habits, genetic predisposition, and physical inactivity can influence energy homeostasis. Dysbiosis, impaired intestinal barrier function, and adipose tissue related inflammation act directly through increased translocation of bacterial endotoxins or lipotoxins, or indirectly, through the regulation of insulin sensitivity and resulting liver steatosis (5). The interplay between gut microbiota and NAFLD onset is summarized and illustrated in Figure 1. Previous studies documented that severity of steatosis in NAFLD patients correlated with small bowel bacterial overgrowth and increased intestinal permeability (6). The novel progresses in knowledge about the human gut microbiota have changed our sight of disease and treatment. Therapeutic manipulations with prebiotics, probiotics, and synbiotic as microbiome-based interventions are potential targets for NAFLD management via modulating the enteric flora (Figure 2). Considering the ease of use of these supplements, their safety and low cost, they beneficial impact on hepatic steatosis and fibrosis (7,8); oral probiotics are live microorganisms that have potentially benefits for the host through its effects in the intestinal tract if consumed in adequate amounts (9). Prebiotics are fermentable fibers that facilitate the growth of probiotics and thereby benefit health (10). Synbiotics which are combination of prebiotics and probiotics have a potentially stronger effect in modulating the gut microbiota than either probiotics or prebiotics alone (11). A meta-analysis has reported probiotic supplementation can improve liver enzymes, serum cholesterol, and insulin sensitivity in patients with NAFLD (12). Evidence of a meta-analysis declare that probiotic and synbiotic supplementation may improve lipid profile, glycemic variable, liver enzymes, and inflammatory mediator by alternating the type and/or function of the intestinal microbiota (11). In our previous study, we found th

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