Gut microbiota modulation in patients with non-alcoholic fatty liver disease: Effects of current treatments and future strategies - PubMed (original) (raw)

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Gut microbiota modulation in patients with non-alcoholic fatty liver disease: Effects of current treatments and future strategies

Marta Maestri et al. Front Nutr. 2023.

Abstract

Non-alcoholic fatty liver disease (NAFLD) is frequently associated with metabolic disorders, being highly prevalent in obese and diabetic patients. Many concomitant factors that promote systemic and liver inflammation are involved in NAFLD pathogenesis, with a growing body of evidence highlighting the key role of the gut microbiota. Indeed, the gut-liver axis has a strong impact in the promotion of NAFLD and in the progression of the wide spectrum of its manifestations, claiming efforts to find effective strategies for gut microbiota modulation. Diet is among the most powerful tools; Western diet negatively affects intestinal permeability and the gut microbiota composition and function, selecting pathobionts, whereas Mediterranean diet fosters health-promoting bacteria, with a favorable impact on lipid and glucose metabolism and liver inflammation. Antibiotics and probiotics have been used to improve NAFLD features, with mixed results. More interestingly, medications used to treat NAFLD-associated comorbidities may also modulate the gut microbiota. Drugs for the treatment of type 2 diabetes mellitus (T2DM), such as metformin, glucagon-like peptide-1 (GLP-1) agonists, and sodium-glucose cotransporter (SGLT) inhibitors, are not only effective in the regulation of glucose homeostasis, but also in the reduction of liver fat content and inflammation, and they are associated with a shift in the gut microbiota composition towards a healthy phenotype. Even bariatric surgery significantly changes the gut microbiota, mostly due to the modification of the gastrointestinal anatomy, with a parallel improvement in histological features of NAFLD. Other options with promising effects in reprogramming the gut-liver axis, such as fecal microbial transplantation (FMT) and next-generation probiotics deserve further investigation for future inclusion in the therapeutic armamentarium of NAFLD.

Keywords: MAFLD; NAFLD; bariatric surgery; diabetes; diet; gut microbiota; metabolomics; probiotics.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1

Changes in gut microbiota have been associated with non-alcoholic fatty liver disease (NAFLD), with progressive alteration of some bacterial components, according to the fibrosis degree. Loss of bacterial diversity and depletion of beneficial bacteria such as Lactobacillus and Bifidobacterium have been described with the progression of NAFLD, together with the increase in Ruminococcus and Escherichia in patients with advanced fibrosis. NAFLD, non-alcoholic fatty liver; NASH, non-alcoholic steatohepatitis.

FIGURE 2

Diet and bariatric surgery effects on the gut microbiota. Adherence to Mediterranean diet (MD) leads to a reduction in intestinal inflammatory bacteria and an increase in beneficial bacteria, including short chain fatty acids (SCFAs)-producing bacteria (mainly Bifidobacterium and Lactobacillus). Most studies agree on the increase in Akkermansia abundance after bariatric surgery (BS). For both MD and BS, the end result is a reduction in inflammation, lipid production and preservation/improvement in the gut barrier function.

FIGURE 3

Anti-diabetic drugs effects on non-alcoholic fatty liver disease (NAFLD) and gut microbiota. GLP-1, glucagon-like peptide 1; SCFA, short-chain fatty acids; SGLT, sodium-glucose cotransporter inhibitors.

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Gut microbiota modulation in patients with non-alcoholic fatty liver disease: Effects of current treatments and future strategies - PubMed (original) (raw)