Acute Phase Inflammatory Proteins, Gut Microbiota Dysbiosis and Severity of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus

Since obesity and type 2 diabetes mellitus (DM) became almost pandemic, incidence and prevalence of associated nonalcoholic fatty liver disease (NAFLD) rose accordingly. Aim of the study was assessing whether there is a link between circulating C-reactive protein(CRP), gut microbiota dysbiosis and severity of liver disease in patients with NAFLD and confirmed type 2 DM. 50 patients diagnosed with type 2 DM were consecutively enrolled in this cross-sectional, pilot study, being evenly divided in two groups, as matched pairs, on the basis of presence or absence of NAFLD confirmed by abdominal and CT exam, after ruling out a lot of diseases and conditions. Patients underwent measurements of waist circumference, blood pressure (BP), body mass index (BMI) and thoroughly physical examination. Complete blood count (CBC), liver tests, CRP, fasting plasma glucose (FPG), low density lipoprotein(LDL) and high-density lipoprotein(HDL) cholesterol, triglycerides, creatinin and uric acid, micro proteinuria as well as stool microbiology were run, using standardized methods. Fatty liver index (FLI) was also calculated. Fibromax (BioPredictive) was performed in NAFLD (+) patients. NAFLD (+) group displayed significant differences of age and BMI, as well as lab biochemistry: ALT, GGT, LDL-cholesterol and triglycerides, CRP, microprotienuria and stool microbiology.. Strong positive correlation of CRP with gut dysbiosis (DB) severity, microproteinuria, as well as with nonalcoholic steatohepatitis (NASH) score, were observed. DB range correlated positively in NAFLD (+) group with age, BMI, BP, dyspepsia as well as with NASH scores. In conclusion patients with NAFLD and associated type 2 DM displayed a specific profile with significant differences of age, BMI, FLI, diabetic treatment, biochemistry and gut microbiological charts. Strong positive correlations between CRP, gut DB and NASH score suggest the possibility of link between inflammation, gut microbiota DB and severity of liver disease.