Association of Nonalcoholic Fatty Liver Disease With Small Intestine Bacterial Overgrowth in Obese Children

Abstract

Introduction: In recent years, NAFLD is considered as the key of the so-called metabolic inflammation, in which the intestinal microbiota plays an important role. The aim: To determine the effect of small intestine bacterial overgrowth on the liver structural and functional parameters in children with obesity and overweight. Materials and methods: The object of the study was 89 children with obesity/overweight. Depending on the presence of SIBO based on the results of the hydrogen breath test with glucose, the patients were divided into 2 groups: first (I) consisted of 31 children with SIBO, the second (II) included 58 children without SIBO. All the patients under study performed a general blood analysis and a biochemical blood test, immuno-enzyme test method with insulin level determination HOMA index calculation. For diagnostics of the liver steatosis, transient elastography with the CAP (controlled attenuation parameter) function was carried out using FibroScan® 502 touch (Echosens, Paris, France). Results: According to fibroscan data, the presence of SIBO in obese children can lead to raise of CAP level; liver steatosis was diagnosed in 22 patients (70.9%) of the 1st group and 24 patients (41.4%) of the 2 group (p<0,05). We found significant differences in the the ratio of neutrophils and lymphocytes (NLR) (p <0.05). The average glucose level and HOMA index were significantly higher in SIBO group (p<0,05). The analysis of risk factors of SIBO showed that metabolic syndrome and NAFLD as the risk factors for SIBO development (p<0,05). Conclusions: SIBO has an effect on the structural and functional characteristics of the liver resulting in higher insulin and glucose level, higher NLR level and greater prevalence of NAFLD.

Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Diseases Related- Current State of Knowledge

“…Some studies show that the prevalence of SIBO in patients with chronic nonalcoholic liver disease can be as high as 35% of the total population, and the prevalence increases with the percentage of men in the population [88,94,95]. Other research suggests that there might be an association between NAFLD and SIBO in children [94,96,97]. Future studies should explore the mechanisms linking SIBO and NAFLD and examine whether treating SIBO could prevent NAFLD in children.…”

“…Future studies should explore the mechanisms linking SIBO and NAFLD and examine whether treating SIBO could prevent NAFLD in children. The analysis of risk factors of SIBO in children showed that metabolic syndrome and NAFLD as the risk factors for SIBO development [94,96,97].…”

“…Presence of SIBO was associated with greater severity of ballooning degeneration on liver biopsy, but not with a significantly higher prevalence of NASH. Additional studies are needed to evaluate the reproducibility and importance of this finding in patients with NAFLD and SIBO [97].…”

Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Related Diseases—Current State of Knowledge

“…The association of NAFLD with SIBO in obese and overweight children has also been studied [97][98][99]. A meta-analysis [100] was conducted based on the three previously mentioned studies, involving 205 children, which indicated a possible relationship between SIBO and NAFLD in children.…”

Epidemiology of small intestinal bacterial overgrowth

“…A meta-analysis of three studies showed that children with SIBO were more likely to have MAFLD (OR = 5.27; 95%CI: 1.66-16.68) and children with MAFLD were at an increased risk of developing SIBO (RR = 2.17; 95%CI: 1.54-2.81)[ 84 ]. Metabolic syndrome and MAFLD were risk factors for SIBO development in obese children[ 85 ].…”