COMMENTARY

Fatty Liver Takes Center Stage

Digestive Disease Week (DDW) 2013

William F. Balistreri, MD

Disclosures

June 04, 2013

In This Article

Role of the Gut Microbiome

An intriguing recent advance is the recognition of the gut microbiome as a major metabolic organ. The endogenous gastrointestinal flora determines how ingested calories are processed, serving as a "caloric gatekeeper" and a "metabolic control tower." The microbiome is considered to have the potential to contribute to the pathogenesis of fatty liver disease through the production of bacterial metabolites that promote deposition of fat and inflammation in the liver. In one reported study,[7] investigators examined the fecal microbial profile in patients with fatty liver disease using combined metagenomic and proteomic approaches. The profiles of the gut microbiome in patients with NAFLD were distinctly different from those of nonobese patients. The metabolite profile of patients with fatty liver disease showed a shift away from carbohydrate and amino acid metabolism to favor energy production, which may contribute to the development of obesity and fatty liver disease.

Further evidence that the gut microflora plays a major role in the pathogenesis of nonalcoholic steatohepatitis (NASH) was presented in a separate study.[8] These investigators found elevated bacterial metabolic products in liver tissue from patients with NASH, supporting the hypothesis that gram-positive cell wall components arising from the gastrointestinal tract exert a direct effect on hepatocytes, causing increased oxidative stress and contributing to tissue injury. These observations offer a possibility that administration of antibiotics or probiotics may be of benefit in the treatment of steatohepatitis.

Characterization of the gut microbiome and bacterial metabolites may also offer a biomarker to diagnose fatty liver disease. Investigators reported that analysis of these compounds in exhaled breath is a promising noninvasive method to detect fatty liver in obese patients.[9,10]

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