Efeitos da intervenção dietética na microbiota intestinal e perfil metabólico-nutricional de pacientes com esteato-hepatite não alcoólica: um ensaio clínico randomizado

Abstract

Introduction: Modulation of the gut microbiota, through diet, emerges as a therapeutic possibility to improve health. Objective: To characterize the intestinal microbiota composition and the metabolic-nutritional profile in patients with non-alcoholic steatohepatitis, as well as the effects of dietary intervention on the aforementioned parameters. Methods: They are presented in two articles. In article 1 (cross-sectional study), partial data from 30 patients with NASH and article 2 (randomized, parallel, open-label study) were analyzed. 40 patients with NASH were allocated to two groups: DIET (individualized diet with 1,651.34 ± 263.25 kg / day, 47% carbohydrates, 28% lipids, 25% proteins and 30.3 ± 4.7 g / day of fiber plus nutritional orientation) and Control (CT - nutritional orientation). The groups were evaluated at baseline and after 3 months of intervention. The study was conducted at the University Hospital-UFJF. Hepatic histology, faecal collection (fecal microbiota), hydrogen and methane respiratory test (bacterial overgrowth in SBID), blood collection (hepatic biochemistry, glycemic and lipid profile), anthropometry, percentage evaluation of body fat and dietary intake. Results: Article 1: Association of fecal microbiota with clinical parameters and diet in nonalcoholic steatohepatitis The highest density of fecal microorganisms was Bacteroidetes [4.77 (3.61-5.81) x 108 cells g-1], which correlated positively with aspartate aminotransferase (p=0.008) and, negatively, with carbohydrate intake (p=0.021). Archaea positively correlated with total cholesterol (p=0.007); Acidobacteria, positively, with lobular inflammation (p = 0.024) and triacylglycerol (p=0.007), Verrucomicrobiales positively with BMI (p = 0.007), Proteobacteria, positively with polyunsaturated ingestion (p = 0.026). The Acidobacteria group was quantified for the first time in adults with NASH [1.57 (1.01-1.83) x 108 g-1 cells]. The results suggest that the intestinal microbiota is probably involved in the modulation of risk factors for NASH. The intervention in the DIET group reduced body weight, waist, percentage of fat, total cholesterol, triacylglycerols, glycemia, insulin, HOMA-IR and transaminases (p<0.05) in relation to baseline. However, the CT group did not present changes in the metabolic- 10 nutritional profile (p>0.05). There was no difference between the groups in the SIBO frequency at baseline (p = 0.723) and after 3 months (p = 0.327). The DIETA group increased total microorganisms (p=0.04), while the CT group reduced Bacteroidetes (p=0.04) and Verrucomicrobiales (p=0.02). The results suggest that exclusively dietary modifications contribute to the health promotion of patients with NASH and should form the basis of nutritional treatment for this condition.