Non-alcoholic steatohepatitis: understanding the relationship between the gut and the liver

Steatotic liver disease associated with metabolic dysfunction (MSD), formerly called non-alcoholic fatty liver disease (NAFLD), popularly known as "fatty liver" or hepatic steatosis, is one of the biggest public health challenges today. This condition is growing alarmingly worldwide and is directly linked to modern lifestyles.

But what is fatty liver, how does it develop and how can taking care of your intestinal health help prevent and treat it?
What is steatotic liver disease associated with metabolic dysfunction (MSD)?

MSD is the most prevalent liver disease today, affecting between 25% and 45% of the world's population and with the highest rate (44,37%) in Latin America. It is considered the manifestation of metabolic syndrome in the liver and is associated with obesity, insulin resistance, type 2 diabetes and dyslipidemia.
The condition can range from simple hepatic steatosis (accumulation of fat in the liver) to more serious conditions such as non-alcoholic steatohepatitis, cirrhosis and liver cancer. Its main characteristic is the deposition of lipids in hepatocytes, the cells responsible for the functioning of the liver.
Symptoms, causes and complications of fatty liver
Often silent, fatty liver can develop without any noticeable symptoms. The main risk factors include

A diet rich in fats and sugars;
A sedentary lifestyle;
● overweight and abdominal obesity;
● insulin resistance and diabetes;
● high levels of cholesterol and high triglycerides.

If left unchecked, the disease can progress to inflammation, fibrosis, cirrhosis and even hepatocellular carcinoma (liver cancer).
How to treat non-alcoholic steatohepatitis
Management mainly involves lifestyle changes, which include:

● a balanced diet rich in fiber;
● regular physical activity;
● reduction and control of body weight;
● control of triglyceride, cholesterol and blood glucose levels.

These measures help to reduce liver fat, balance the metabolism and slow down the progression of the disease.
The gut-liver link and intestinal health
Recent research points to a strong link between the development of fat in the liver and the intestine-liver axis.
Many patients suffer from intestinal dysbiosis (an imbalance in the microbiota). This increases intestinal permeability, allowing bacteria and toxins to cross the intestinal barrier and reach the bloodstream.
The result is so-called endotoxemia, i.e. the presence of endotoxins (toxic substances released by Gram-negative bacteria) in the bloodstream, which overloads the liver and stimulates chronic low-grade inflammatory processes. This inflammation is directly involved in the progression of MSD and complications such as hepatic encephalopathy.
Probiotics, prebiotics and symbiotics: allies in the treatment of fatty liver
Balancing the intestinal flora is gaining prominence as a prevention and treatment strategy. Supplementation with probiotics (beneficial living microorganisms), prebiotics (fibers that serve as food for good bacteria) and symbiotics (a combination of probiotics and prebiotics) has been widely studied and is already showing promising results.
Among the documented benefits are reduced inflammation, improved liver function, lower LDL cholesterol concentrations and an improved lipid profile.
Prebiotics have shown consistent effects in improving lipid metabolism, while probiotics stand out in protecting against liver damage.

Integrated strategies for liver health
Steatotic liver disease associated with metabolic dysfunction is a complex and multifactorial condition. However, knowledge of its link to intestinal health opens up new possibilities for care.
The combination of lifestyle changes with probiotic, prebiotic and symbiotic supplementation represents a promising way forward:

● slow down the progression of hepatic steatosis;
● reduce hepatic and metabolic complications;
● improve patients' quality of life.

In other words: taking care of your gut is also taking care of your liver. This integration shows that digestive health and liver health go hand in hand and that investing in balance can be the key to preventing complications and living better.

Source: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1155306/full
https://www.scielo.br/j/ag/a/S7DZVcpY8KnKrkJRSM4LPJP/?format=html&lang=en
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-024-03356-y
https://pubmed.ncbi.nlm.nih.gov/36626630/