Diet Affects Gut Microbiota and Modulates Hospitalization Risk Differentially In an International Cirrhosis Cohort

Abstract

The relative ranking of cirrhosis-related deaths differs between high/middle-income countries. Gut microbiome is affected in cirrhosis and related to diet. Our aim was to determine the effect of differing dietary habits on gut microbiota and clinical outcomes.

Methods: Outpatient compensated/decompensated cirrhotics and controls from Turkey and USA underwent dietary and stool microbiota analysis. Cirrhotics were followed till 90-day hospitalizations. Shannon diversity and multi-variable determinants (Cox and binary logistic) of microbial diversity and hospitalizations were studied within/between groups.

Results: 296 subjects (157 USA:48 controls, 59 compensated, 50 decompensated, 139 Turkey:46 controls, 50 compensated, 43 decompensated) were included. Cirrhotics between cohorts had similar MELD scores. American cirrhotics had more men, greater rifaximin/lactulose use and higher hepatitis C/alcohol etiologies. Coffee intake was higher in Americans while tea, fermented milk and chocolate intake were higher in Turkey. The entire Turkish cohort had a significantly higher diversity than Americans, which did not change between their controls and cirrhotics. In contrast, diversity changed in the US-based cohort and was the lowest in decompensated patients. Coffee, tea, vegetable, chocolate and fermented milk intake predicted a higher diversity while MELD score, lactulose use and carbonated beverage use predicted a lower microbial diversity. The Turkish cohort had a lower risk of 90-day hospitalizations. On Cox and binary logistic regression, microbial diversity was protective against 90-day hospitalizations, along with coffee/tea, vegetable and cereal intake.

Conclusions: In this study of cirrhotic patients and healthy controls from USA and Turkey, a diet rich in fermented milk, vegetables, cereals, coffee and tea, is associated with a higher microbial diversity. Microbial diversity was associated with an independently lower risk of 90-day hospitalizations. This article is protected by copyright. All rights reserved.

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