Diet, Gut Dysbiosis and Liver Cirrhosis and their Influence upon Hepatic Encephalopathy
Main Article Content
Abstract
Cirrhosis is the end stage of progressive liver fibrosis, resulted from chronic inflammation and liver injury. Early identification of risk factors and appropriate treatment for hepatic decompensation is paramount for positive health outcomes. In this review study, we revisited mechanisms associated with gut dysbiosis and intestinal hyperpermeability in advanced liver disease, and further discussed nutritional strategies for the management of dysbiosis in liver cirrhosis. In gut dysbiosis, proportionally lower concentrations of bacteria belonging to beneficial taxa such as Lachnospiraceae, Clostridiales, Ruminococcaceae and Veillonellaceae and others are observed, in relation to pathogenic taxa such as Enterobacteriaceae, Bacteroidaceae and others. Cirrhotic patients present decreased bowel motility, bacterial overgrowth and increased intestinal permeability. Dysbiosis may further exacerbate such conditions due to the ability of pathogenic bacteria to adhere to the epithelium, produce endotoxin, disrupt bile acid metabolism, activate the immune system and trigger inflammation, in a vicious cycle. The triad hepatic encephalopathy – cirrhosis – gut dysbiosis is an evident entity, and primary prevention as well as management strategies for those three conditions aim strongly at improving intestinal health by focusing on nutritional interventions. High-protein diets may be recommended for cirrhosis patients, and the protein source is a key factor to consider, and so are dietary fibre and carbohydrate compositions. Attention is given to reduce saturated fat intake. Supplementation with branched-chain amino acids, probiotics and prebiotics have also shown positive results.
Keywords:
Diet, dysbiosis, microbiome, cirrhosis, hepatic encephalopathy
Article Details
How to Cite
DE JESUS, Rosângela Passos et al.
Diet, Gut Dysbiosis and Liver Cirrhosis and their Influence upon Hepatic Encephalopathy.
Medical Research Archives, [S.l.], v. 10, n. 8, aug. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2915>. Date accessed: 24 dec. 2024.
doi: https://doi.org/10.18103/mra.v10i8.2915.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151-71. doi:10.1016/j.jhep.2018.09.014.
3. Woodhouse CA, Patel VC, Singanayagam A, Shawcross DL. Review article: the gut microbiome as a therapeutic target in the pathogenesis and treatment of chronic liver disease. Aliment Pharmacol Ther. 2018;47(2):192-202. doi:10.1111/apt.14397.
4. Gunnarsdottir SA, Sadik R, Shev S, et al. Small intestinal motility disturbances and bacterial overgrowth in patients with liver cirrhosis and portal hypertension. Am J Gastroenterol. 2003;98(6):1362-70. doi:10.1016/S0002-9270(03)00250-8.
5. Thalheimer U, Triantos CK, Samonakis DN, Patch D, Burroughs AK. Infection, coagulation, and variceal bleeding in cirrhosis. Gut. 2005;54(4):556-63.doi:10.1136/gut.2004.048181.
6. Albillos A, de la Hera A, Gonzalez M, et al. Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement. Hepatology. 2003;37(1):208-17.doi: 10.1053/jhep.2003.50038.
7. Gomez-Hurtado I, Such J, Sanz Y, Frances R. Gut microbiota-related complications in cirrhosis. World J Gastroenterol. 2014;20(42):15624-31. doi:10.3748/wjg.v20.i42.15624.
8. Thursby E, Juge N. Introduction to the human gut microbiota. Biochem J. 2017;474(11):1823-1836. doi:10.1042/BCJ20160510.
9. Ridlon JM, Alves JM, Hylemon PB, Bajaj JS. Cirrhosis, bile acids and gut microbiota: unraveling a complex relationship. Gut Microbes. 2013;4(5):382-7. doi:10.4161/gmic.25723.
10. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.doi:10.1002/hep.29367.
11. Monteiro CA, Cannon G, Lawrence M, Costa Louzada ML, Pereira Machado P. 2019. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO.
12. Monteiro CA, Moubarac J., Cannon G, Ng S, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obesity Rev. 2014; 2:21-28.doi: 10.1111/obr.12107.
13. Jarvis H, Craig D, Barker R, et al. Metabolic risk factors and incident advanced liver disease in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of population-based observational studies. PLoS Med.2020;17(4):e1003100. doi:10.1371/journal.pmed.1003100.
14. Zadeh SH, Mansoori A, Hosseinzadeh M. Relationship between dietary patterns and non-alcoholic fatty liver disease: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2020.doi:10.1111/jgh.15363.
15. Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol. 2020;73(1):202-209. doi:10.1016/j.jhep.2020.03.039.
16. Di Lorenzo F, De Castro C, Silipo A, Molinaro A. Lipopolysaccharide structures of gram-negative populations in the gut microbiota and effects on host interactions. FEMS Microbiol Rev.2019;43(3):257-272. doi:10.1093/femsre/fuz002.
17. Moszak M, Szulińska M, Bogdański P. You Are What You Eat-The Relationship between Diet, Microbiota, and Metabolic Disorders-A Review. Nutrients. 2020;12(4):1096.doi: 10.3390/nu12041096.
18. Gentile CL, Weir T.L. The gut microbiota at the intersection of diet and human health. Science. 2018; 362:776–780.doi: 10.1126/science.aau5812.
19. Madsen L, Myrmel LS, Fjære E, Liaset B, Kristiansen K. Links between Dietary Protein Sources, the Gut Microbiota, and Obesity. Front Physiol. 2017; 8:1047.doi: 10.3389/fphys.2017.01047.
20. Zhao F, Huang Z, Zhou G, Li H, Xu X, Li C. Dietary proteins rapidly altered the microbial composition in rat caecum. Curr. Microbiol. 2017; 74:1447–1452. doi:10.1007/s00284-017-1339-2.
21. Fava F, Gitau R, Griffin BA, Gibson GR, Tuohy KM, Lovegrove JA. The type and quantity of dietary fat and carbohydrate alter faecal microbiome and short-chain fatty acid excretion in a metabolic syndrome 'at-risk' population. Int J Obes (Lond). 2013; 37(2):216-23. doi:10.1038/ijo.2012.33.
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