ESPEN 2013 - Abstract Submission
Liver and gastrointestinal tract
ESPEN13-1693
IMPACT OF DIETARY WEIGHT LOSS THERAPY ON THE INTESTINAL BARRIER IN OBESE SUBJECTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
A. Damms Machado 1,*A. Schnitzer 1M. Basrai 1S. C. Bischoff 1
1Dept. of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
Rationale: Non-alcoholic fatty liver disease (NAFLD) is closely linked to obesity being considered as the hepatic manifestation of the metabolic syndrome. There is growing body of evidence suggesting that the progression of NAFLD is promoted by bacterial translocation through the intestinal wall as consequence of an increased intestinal permeability.
Methods: Aim of the study was to investigate the prevalence of intestinal hyperpermeability in obese patients with NAFLD (n=55) compared to obese subjects without NAFLD (n=44) using a two sugar probe permeability test (Lactulose/Mannitol, L/M) and determination of fecal zonulin. Gut permeability was further assessed in 27 subjects with NAFLD who underwent a dietary weight loss regimen accompanied by lifestyle intervention over a period of 1 year resulting in a relative weight loss of 17%.
Results: Patients with NAFLD showed a significantly increased intestinal permeability compared to controls (L/M 0.035±0.014 vs 0.022±0.007,p<0.001, fecal zonulin 1757.3±1252 ng/ml, 1116.7±88 ng/ml,p=0.0237). In subjects with NAFLD undergoing weight loss therapy the L/M index decreased from 0.049±0.009 to 0.017±0.005 within 1 year and reached the normal range (<0.03) after 6 months. Fecal zonulin was 53.2% reduced within 3 months, but returned to baseline after 1 year. Moreover, there was a significant correlation of L/M with CRP (r=0.34, p<0.01), Glutamic-pyruvate transaminase (0.30, p<0.01) and severity of steatosis (r=0.63, p<0.001).
Conclusion: The results support the hypothesis that NAFLD in humans is associated with increased gut permeability. Moreover, the data provide first evidence that dietary weight loss profoundly improves altered barrier function which may play an important role in the pathogenesis of hepatic fat deposition, thus indicating a key function in the observed improvement of metabolic liver disease.
Disclosure of Interest: None Declared
Keywords: Intestinal barrierNon-alcoholic fatty liver disease