Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Dr. Peset, 46017 Valencia, Spain.
Experimental Hepatology Joint Unit, Health Research Institute La Fe-University of Valencia, 46026 Valencia, Spain.
Nutrients. 2023 Jul 18;15(14):3187. doi: 10.3390/nu15143187.
Bariatric surgery (BS) has several benefits, including resolution of non-alcoholic fatty liver disease (NAFLD) in many patients. However, a significant percentage of patients do not experience improvement in fatty liver after BS, and more than 10% develop new or worsening NAFLD features. Therefore, a question that remains unanswered is why some patients experience resolved NAFLD after BS and others do not. In this study, we investigated the fecal microbiota and plasma bile acids associated with NAFLD resolution in twelve morbidly obese patients undergoing BS, of whom six resolved their steatosis one year after surgery and another six did not. Results indicate that the hallmark of the gut microbiota in responder patients is a greater abundance of Bacteroides, Akkermansia, and several species of the Clostridia class (genera: Blautia, Faecalibacterium, Roseburia, Butyricicoccusa, and Clostridium), along with a decreased abundance of Actinomycetes/Bifidobacterium and Faecalicatena. NAFLD resolution was also associated with a sustained increase in primary bile acids (particularly non-conjugated), which likely results from a reduction in bacterial gut species capable of generating secondary bile acids. We conclude that there are specific changes in gut microbiota and plasma bile acids that could contribute to resolving NAFLD in BS patients. The knowledge acquired can help to design interventions with prebiotics and/or probiotics to promote a gut microbiome that favors NAFLD resolution.
减重手术（BS）有许多益处，包括许多患者的非酒精性脂肪肝（NAFLD）得到解决。然而，相当一部分患者在 BS 后并未改善脂肪肝，超过 10%的患者出现新的或恶化的 NAFLD 特征。因此，一个悬而未决的问题是为什么一些患者在 BS 后会解决 NAFLD，而另一些患者则不会。在这项研究中，我们调查了与 12 名接受 BS 的病态肥胖患者的 NAFLD 缓解相关的粪便微生物群和血浆胆汁酸，其中 6 名患者在手术后一年解决了脂肪变性，而另外 6 名患者则没有。结果表明，应答者患者肠道微生物群的标志是拟杆菌、阿克曼氏菌和几种梭菌属（属：布劳特氏菌、粪杆菌、罗斯伯里氏菌、丁酸梭菌和梭菌）的丰度增加，同时放线菌/双歧杆菌和粪球菌的丰度降低。NAFLD 的缓解还与初级胆汁酸（特别是非结合型）的持续增加相关，这可能是由于能够产生次级胆汁酸的细菌肠道物种减少所致。我们得出结论，BS 患者的肠道微生物群和血浆胆汁酸存在特定的变化，这可能有助于解决 NAFLD。所获得的知识可以帮助设计使用益生元和/或益生菌的干预措施，以促进有利于 NAFLD 缓解的肠道微生物组。
