March 28, 2020
2 min read

Diet, microbiota changes linked with minimal hepatic encephalopathy in cirrhosis

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Jasmohan Bajaj

Changes in diet and microbiota were linked with minimal hepatic encephalopathy and hospitalizations in patients with cirrhosis from Mexico compared with American patients, according to research published in Liver International.

Jasmohan S. Bajaj, MD, of the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University, told Healio Gastroenterology and Liver Disease that dietary habits, socio-economic status and genetics, which vary worldwide, affect gut microbiota and could affect progression of cirrhosis and other liver diseases.

“Therefore, we sought to compare salivary and gut microbiota and their relationships with diet, hospitalizations and brain functions in age-balanced people with and without cirrhosis from United States of America and Mexico,” he said. “Despite being a middle-income country, Mexico is unique because of the high prevalence of obesity that parallels the U.S. In addition, high lactose intolerance and relatively lower protein intake in the Mexican diet makes it important to compare with the typical Western diet in the U.S.”

Researchers included controls and aged-balanced patients (n = 275) with compensated/decompensated cirrhosis and followed them for 90 days. They analyzed dietary, salivary and fecal microbiota parameters between and within countries and a subset of patients also underwent minimal hepatic encephalopathy (MHE) testing.

The study included 133 patients from the U.S. (40 controls, 50 with compensated cirrhosis and 43 with decompensated cirrhosis) and 142 patients from Mexico (41 controls, 49 with compensated cirrhosis and 52 with decompensated cirrhosis).

Investigators found that diet showed lower protein and animal fat intake in all patients with decompensated cirrhosis. However, it was worse in patients from Mexico. Diversity was lower in stool and saliva among patients with decompensated cirrhosis, and again, it was worse in Mexico. Finally, Prevotellaceae were lower among patients with decompensated cirrhosis, particularly among patients with lower animal fat/protein intake across both countries.

Researchers found that patients from Mexico had higher rates of hospitalization than patients from the U.S. (26% vs. 14%; P = .04).

In their analysis, Bajaj and colleagues found that Prevotellaceae, Ruminococcaceae and Lachnospiraceae lowered hospitalization risk independent of model for end-stage liver disease and ascites. The rate for MHE was similar among the 120 patients among which it was performed. Researchers found that MELD and decompensation increased the risk for MHE, while cirrhosis dysbiosis ratio and Prevotellaceae decreased the risk for MHE.

“This study and our prior comparison with data from Turkey shows that each country represents a unique combination of diet, host genetics and socio-economic challenges which affect gut microbiota and prognosis of cirrhosis,” Bajaj said. “Therefore, one country does not fit all, and a global perspective is necessary in gut-brain axis and cirrhosis research."


Cox IJ, et al. Liver Int. 2019;doi: 10.1111/liv.14256.

Disclosure: The authors report no relevant financial disclosures.