Cognition and hospitalizations are linked with salivary and faecal microbiota in cirrhosis cohorts from the USA and Mexico

Cognition and hospitalizations are linked with salivary and faecal microbiota in cirrhosis cohorts from the USA and Mexico

Background & Aims Gut microbiota are affected by diet and ethnicity, which impacts cognition and hospitalizations in cirrhosis. Aim: Study interactions of diet with microbiota and impact on hospitalizations and cognition in American and Mexican cohorts. Methods Controls and age‐balanced patients...

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Published in:Liver international Vol. 40; no. 6; pp. 1395 - 1407
Main Authors: Bajaj, Jasmohan S., Torre, Aldo, Rojas, Mayra L., Fagan, Andrew, Nandez, Ivvone E., Gavis, Edith A., De Leon Osorio, Omar, White, Melanie B., Fuchs, Michael, Sikaroodi, Masoumeh, Gillevet, Patrick M.
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01-06-2020
Subjects:
Animal fat
animal fats and protein
Ascites
Cirrhosis
Cognition
Cognition & reasoning
Control methods
Diet
Dysbacteriosis
gut‐brain axis
Hepatic encephalopathy
Hospitalization
Intestinal microflora
lactose intolerance
Liver cirrhosis
Microbiota
Minority & ethnic groups
Prevotellaceae
Proteins
Regression analysis
Saliva
Subgroups
Western diet
United States > US
Mexico
lactose intolerance
animal fats and protein
hepatic encephalopathy
Western diet
gut-brain axis
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Summary:Background & Aims Gut microbiota are affected by diet and ethnicity, which impacts cognition and hospitalizations in cirrhosis. Aim: Study interactions of diet with microbiota and impact on hospitalizations and cognition in American and Mexican cohorts. Methods Controls and age‐balanced patients with compensated/decompensated cirrhosis were included and followed for 90‐day hospitalizations. A subset underwent minimal hepatic encephalopathy (MHE) testing. Parameters such as dietary, salivary and faecal microbiota (diversity, taxa analysis, cirrhosis dysbiosis ratio CDR:high = good) between/within countries were analysed. Regression analyses for hospitalizations and MHE were performed. Results In all, 275 age‐balanced subjects (133 US [40 Control, 50 Compensated, 43 Decompensated] and 142 Mexican [41 Control, 49 Compensated, 52 Decompensated]) were enrolled. MELD/cirrhosis severity was comparable. Diet showed lower protein and animal fat intake in all decompensated patients, but this was worse in Mexico. Diversity was lower in stool and saliva in decompensated patients, and worse in Mexican cohorts. Prevotellaceae were lower in decompensated cirrhosis, particularly those with lower animal fat/protein consumption across countries. Hospitalizations were higher in Mexico vs the USA (26% vs 14%, P = .04). On regression, Prevotellaceae, Ruminococcaceae and Lachnospiraceae lowered hospitalization risk independent of MELD and ascites. MHE testing was performed in 120 (60/country and 20/subgroup) subjects and MHE rate was similar. MELD and decompensation increased while CDR and Prevotellaceae decreased the risk of MHE. Conclusions Changes in diet and microbiota, especially related to animal fat and protein intake and Prevotellaceae, are associated with MHE and hospitalizations in Mexican patients with cirrhosis compared to an American cohort. Nutritional counselling to increase protein intake in cirrhosis could help prevent these hospitalizations.
Bibliography:Funding information
In part by VA Merit Review 2I0CX001076, R01HS025412 and R21TR002024 awarded to JSB. The sponsors did not have any role in study design, collection, analysis, and interpretation of the data and in the writing of the report.
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ISSN:1478-3223
1478-3231
DOI:10.1111/liv.14437