Premium
Cognition and hospitalizations are linked with salivary and faecal microbiota in cirrhosis cohorts from the USA and Mexico
Author(s) -
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.
Publication year - 2020
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14437
Subject(s) - lachnospiraceae , medicine , gut flora , cirrhosis , hepatic encephalopathy , ascites , microbiome , dysbiosis , gastroenterology , physiology , immunology , biology , bioinformatics , genetics , 16s ribosomal rna , bacteria , firmicutes
Abstract 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.