Bile Acids and Dysbiosis in Non-Alcoholic Fatty Liver DiseaseReportar como inadecuado

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Background and Aims

Non-alcoholic fatty liver disease NAFLD is characterized by dysbiosis. The bidirectional effects between intestinal microbiota IM and bile acids BA suggest that dysbiosis may be accompanied by an altered bile acid BA homeostasis, which in turn can contribute to the metabolic dysregulation seen in NAFLD. This study sought to examine BA homeostasis in patients with NAFLD and to relate that with IM data.


This was a prospective, cross-sectional study of adults with biopsy-confirmed NAFLD non-alcoholic fatty liver: NAFL or non-alcoholic steatohepatitis: NASH and healthy controls HC. Clinical and laboratory data, stool samples and 7-day food records were collected. Fecal BA profiles, serum markers of BA synthesis 7-alpha-hydroxy-4-cholesten-3-one C4 and intestinal BA signalling, as well as IM composition were assessed.


53 subjects were included: 25 HC, 12 NAFL and 16 NASH. Levels of total fecal BA, cholic acid CA, chenodeoxycholic acid CDCA and BA synthesis were higher in patients with NASH compared to HC p<0.05 for all comparisons. The primary to secondary BA ratio was higher in NASH compared to HC p = 0.004, but ratio of conjugated to unconjugated BAs was not different between the groups. Bacteroidetes and Clostridium leptum counts were decreased in in a subset of 16 patients with NASH compared to 25 HC, after adjusting for body mass index and weight-adjusted calorie intake p = 0.028 and p = 0.030, respectively. C. leptum was positively correlated with fecal unconjugated lithocholic acid LCA r = 0.526, p = 0.003 and inversely with unconjugated CA r = -0.669, p<0.0001 and unconjugated CDCA r = - 0.630, p<0.0001. FGF19 levels were not different between the groups p = 0.114.


In adults with NAFLD, dysbiosis is associated with altered BA homeostasis, which renders them at increased risk of hepatic injury.

Autor: Marialena Mouzaki , Alice Y. Wang , Robert Bandsma, Elena M. Comelli, Bianca M. Arendt, Ling Zhang, Scott Fung, Sandra E. Fischer



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