Bacterial endotoxin and non‐alcoholic fatty liver disease in the general population: a prospective cohort study. Issue 6 (23rd July 2015)

• Record Type: Journal Article
• Authors: Wong, V. W.‐S.; Wong, G. L.‐H.; Chan, H.‐Y.; Yeung, D. K.‐W.; Chan, R. S.‐M.; Chim, A. M.‐L.; Chan, C. K.‐M.; Tse, Y.‐K.; Woo, J.; Chu, W. C.‐W.; Chan, H. L.‐Y.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 42:Issue 6(2015)
• Page Start: 731
• Page End: 740
• Publication Date: 2015-07-23
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13327
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt13327-abs-0001"> <title>Summary</title> <sec id="apt13327-sec-0001" sec-type="section"> <title>Background</title> <p>Patients with non‐alcoholic steatohepatitis (NASH) have increased intestinal permeability and small intestine bacterial overgrowth.</p> </sec> <sec id="apt13327-sec-0002" sec-type="section"> <title>Aims</title> <p>To test the hypothesis that endotoxemia is associated with non‐alcoholic fatty liver disease (NAFLD) in the general population, and to study dietary factors associated with endotoxemia.</p> </sec> <sec id="apt13327-sec-0003" sec-type="section"> <title>Methods</title> <p>Nine hundred and twenty adults were randomly selected from the government's census database and underwent proton‐magnetic resonance spectroscopy to assess hepatic steatosis. Endotoxemia was assessed using the limulus amebocyte lysate, lipopolysaccharide‐binding protein (LBP) and EndoCab immunoglobulin G (IgG) assays.</p> </sec> <sec id="apt13327-sec-0004" sec-type="section"> <title>Results</title> <p>Two hundred and sixty‐three (29%) subjects had NAFLD. Subjects with NAFLD had slightly higher LBP (<italic>P</italic> < 0.001) and EndoCab IgG (<italic>P</italic> = 0.013) levels. EndoCab IgG remained an independent factor associated with intrahepatic triglycerides after adjusting for other metabolic factors. Among 565 subjects without NAFLD at baseline who had repeated assessment at a median interval of 47 months, 78 (13.8%) developed incident NAFLD and they also had higher LBP (<italic>P</italic> = 0.016). Moreover, LBP was associated with insulin resistance and dyslipidaemia, and modestly increased with the cytokeratin‐18 fragment level but not liver stiffness measurement by transient elastography. Although total energy consumption and individual macronutrients were not associated with endotoxemia, current drinkers (mostly <140 g/week) had lower endotoxin, EndoCab IgG and fetuin‐A levels than nondrinkers.</p> </sec> <sec id="apt13327-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Endotoxin markers are associated with NAFLD in the general population, but do not have a major effect on NASH and fibrosis. People with modest alcohol consumption have lower serum endotoxin. This may partly explain the lower risk of NAFLD and NASH in modest drinkers in previous observational studies.</p> </sec> </abstract>