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Digestive Diseases and Sciences

, Volume 57, Issue 7, pp 1932–1941 | Cite as

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

  • Valentina Volynets
  • Markus A. Küper
  • Stefan Strahl
  • Ina B. Maier
  • Astrid Spruss
  • Sabine Wagnerberger
  • Alfred Königsrainer
  • Stephan C. Bischoff
  • Ina Bergheim
Original Article

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.

Keywords

Intestinal barrier PAI-1 Carbohydrate Protein Ethanol Endotoxin 

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

Notes

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

None.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Valentina Volynets
    • 1
  • Markus A. Küper
    • 2
  • Stefan Strahl
    • 3
  • Ina B. Maier
    • 1
  • Astrid Spruss
    • 1
  • Sabine Wagnerberger
    • 1
  • Alfred Königsrainer
    • 2
  • Stephan C. Bischoff
    • 1
  • Ina Bergheim
    • 1
  1. 1.Department of Nutritional Medicine (180a)University of HohenheimStuttgartGermany
  2. 2.Department of General, Visceral and Transplant SurgeryTuebingen University HospitalTuebingenGermany
  3. 3.Liver Center, City Hospital EsslingenEsslingenGermany

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