1 Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
2 Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
3 George Mason University, Manassas, Virginia, USA.
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. Dietary, salivary and fecal microbiota (diversity, taxa-analysis, cirrhosis dysbiosis ratio CDR:high=good) parameters between/within countries were analyzed. Regression analyses for hospitalizations and MHE were performed.
RESULTS: 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 US (26% vs 14%,p=0.04). 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, 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 counseling to increase protein intake in cirrhosis could help prevent these hospitalizations.