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Nutrition, Intestinal Permeability, and Blood Ethanol Levels Are Altered in Patients with Nonalcoholic Fatty Liver Disease (NAFLD)

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Abstract

Background

A role of an altered dietary pattern (e.g., a diet rich in sugar) but also alterations at the level of the intestinal barrier have repeatedly been discussed to be involved in the development and progression of nonalcoholic fatty liver disease (NAFLD).

Aims

To determine if the nutritional intake, intestinal flora, and permeability and the development of NAFLD are related in humans.

Methods

Ten controls and 20 patients with NAFLD ranging from simple steatosis to steatohepatitis were included in the study. Bacterial overgrowth, orocecal transit time, and intestinal permeability were assessed. Alcohol, endotoxin, and plasminogen activator inhibitor (PAI-) 1 concentration were determined in plasma. Nutritional intake was assessed using a dietary history.

Results

Despite no differences in the prevalence of bacterial overgrowth and in the orocecal transit time, intestinal permeability, alcohol, and endotoxin levels in plasma were significantly higher in patients with NAFLD than in controls. Similar results were also found for PAI-1 plasma concentrations. Patients with NAFLD had a significantly higher intake of protein, total carbohydrates, and mono- as well as disaccharides than controls. PAI-1, endotoxin, and ALT plasma levels were positively related to total protein and carbohydrate intake.

Conclusions

Taken together, our results indicate that intestinal permeability, endogenous alcohol synthesis, and nutritional intake are markedly altered in patients with NAFLD.

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Abbreviations

ADH:

Alcohol dehydrogenase

ALT:

Alanine-aminotransferase

AST:

Aspartate-aminotransferase

BMI:

Body mass index

DBP:

Diastolic blood pressure

γ-GT:

γ-Glutamyl transpeptidase

HPAE-PAD:

High-performance-anion-exchange chromatography with pulsed amperometric detection

LBP:

Lipopolysaccharide binding protein

MUFA:

Monounsaturated fatty acids

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

OCTT:

Orocecal transit time

PAI-1:

Plasminogen activator inhibitor 1

PUFA:

Polyunsaturated fatty acids

SBP:

Systolic blood pressure

SD:

Standard deviation

SEM:

Standard error of mean

SFA:

Saturated fatty acids

SIBO:

Small intestinal bacterial overgrowth

TLR-4:

Toll-like receptor 4

TNF-α:

Tumor necrosis factor alpha

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Acknowledgments

We would like to thank Prof. Dr. J.C. Bode and Prof. Dr. K.-P. Maier for their advice and the accompanying evaluation of the liver status of patients and controls included in the study. We further would like to thank Drs. C. Schäfer and K. Dirks for their assistance with the recruitment of patients for the study. We also would like to thank Prof. Dr. A. Heyar for his technical support with the determination of lactulose and mannitol concentrations in urine samples. This study was supported by a grant from the Center of Nutritional Medicine Hohenheim/Tübingen (PIs: AK and IB).

Conflict of interest

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Authors and Affiliations

  1. Department of Nutritional Medicine (180a), University of Hohenheim, Fruwirthstraße 12, 70599, Stuttgart, Germany

    Valentina Volynets, Ina B. Maier, Astrid Spruss, Sabine Wagnerberger, Stephan C. Bischoff & Ina Bergheim

  2. Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Markus A. Küper & Alfred Königsrainer

  3. Liver Center, City Hospital Esslingen, Hirschlandstraße 97, 73730, Esslingen, Germany

    Stefan Strahl

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  1. Valentina Volynets
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Correspondence to Ina Bergheim.

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Volynets, V., Küper, M.A., Strahl, S. et al. Nutrition, Intestinal Permeability, and Blood Ethanol Levels Are Altered in Patients with Nonalcoholic Fatty Liver Disease (NAFLD). Dig Dis Sci 57, 1932–1941 (2012). https://doi.org/10.1007/s10620-012-2112-9

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  • DOI: https://doi.org/10.1007/s10620-012-2112-9

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