Association of worsening of nonalcoholic fatty liver disease with cardiometabolic function and intestinal bacterial overgrowth: A cross-sectional study

Marília Marques Pereira Lira; José Eymard Moraes de Medeiros Filho; Vinícius José Baccin Martins; Gitana da Silva; Francisco Antônio de Oliveira Junior; Éder Jackson Bezerra de Almeida Filho; Alexandre Sérgio Silva; João Henrique da Costa-Silva; José Luiz de Brito Alves

doi:10.1371/journal.pone.0237360

Association of worsening of nonalcoholic fatty liver disease with cardiometabolic function and intestinal bacterial overgrowth: A cross-sectional study

PLoS One. 2020 Aug 26;15(8):e0237360. doi: 10.1371/journal.pone.0237360. eCollection 2020.

Affiliations

¹ Department of Nutrition, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
² Department of Internal Medicine, Medical Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
³ Lauro Wanderley Hospital, Federal University of Paraiba, João Pessoa, Brazil.
⁴ Department of Physiology and Pathology, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
⁵ Department of Physical Education, Health Sciences Center, Federal University of Paraiba, João Pessoa, Brazil.
⁶ Department of Physical Education and Sport Sciences, Federal University of Pernambuco, Vitória de Santo Antão, PE, Brazil.

Abstract

Background & aims: Non-alcoholic fatty liver disease (NAFLD) has been associated with small bowel bacterial overgrowth (SIBO) and cardiometabolic dysfunction. This cross-sectional study aimed to evaluate the cardio-metabolic parameters and SIBO in patients with different degrees of hepatic fibrosis estimated by NAFLD fibrosis score (NFS).

Methods: Subjects (n = 78) were allocated to three groups: Healthy control (n = 30), NAFLD with low risk of advanced fibrosis (NAFLD-LRAF, n = 17) and NAFLD with a high risk of advanced fibrosis (NAFLD-HRAF, n = 31). Anthropometrics, blood pressure, electrocardiogram and heart rate variability (HRV) were evaluated. Only the NAFLD-LRAF and NAFLD-HRAF groups were submitted to blood biochemical analysis and glucose hydrogen breath tests.

Results: The NAFLD-HRAF group had higher age and body mass index when compared to the control and NAFLD-LRAF groups. The prevalence of SIBO in the NAFLD group was 8.33%. The low frequency/high-frequency ratio (LF/HF ratio) was augmented in NAFLD-LRAF (p < 0.05) when compared with control group. NAFLD-HRAF group had a wide QRS complex (p < 0.05) and reduced LF/HF ratio (p < 0.05) compared to the control and NAFLD-LRAF groups. Serum levels of albumin and platelets were more reduced in the NAFLD-HRAF subjects (p < 0.05) than in the NAFLD-LRAF.

Conclusions: NAFLD impairs cardiac autonomic function. Greater impairment was found in subjects with a worse degree of hepatic fibrosis estimated by NFS. Hypoalbuminemia and thrombocytopenia were higher in subjects with a worse degree of hepatic fibrosis, whereas prevalence of SIBO positive was similar between the groups.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bacteria / growth & development*
Case-Control Studies
Cross-Sectional Studies
Disease Progression*
Electrocardiography
Female
Fibrosis
Heart Rate
Humans
Intestines / microbiology*
Male
Middle Aged
Myocardium / metabolism*
Non-alcoholic Fatty Liver Disease / metabolism*
Non-alcoholic Fatty Liver Disease / microbiology*
Non-alcoholic Fatty Liver Disease / pathology
Non-alcoholic Fatty Liver Disease / physiopathology
Risk

Grants and funding

The authors thank the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior- CAPES, Brazil) for financial aid to students support (code 0002) awarded to MMPL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.