April 5, 2021

Interaction of Microbiome, Diet and Hospitalizations between Brazilian and American Patients with Cirrhosis

M R Alvares-da-Silva et al, 2021. Interaction of Microbiome, Diet and Hospitalizations between Brazilian and American Patients with Cirrhosis, Clinical Gastroenterology and Hepatology.


Background/aims: Gut microbiota are affected by diet, country and affects outcomes in cirrhosis. Western diets are associated with dysbiosis. Comparisons with other diets is needed.

Aim: Compare cirrhosis patients from USA to Brazil with respect to diet, microbiota, and impact on hospitalizations.

Methods: Healthy controls and compensated/decompensated outpatients with cirrhosis from USA and Brazil underwent dietary recall and stool for 16S rRNA sequencing. Demographics, medications/cirrhosis details were compared within/between countries. Patients with cirrhosis were followed for 90-day hospitalizations. Regression for Shannon diversity was performed within cirrhosis. Regression for hospitalizations adjusting for clinical and microbial variables was performed.

Results: MELD, diabetes, ascites, albumin was similar, but more Americans were men, had higher hepatic encephalopathy and alcohol/hepatitis C etiology with lower NAFLD than Brazilians. Brazilians had higher cereal, rice, and yogurt intake versus USA. As disease progressed cereals, rice/beans, coffee, and chocolate consumption reduced. Microbial diversity was higher in Brazilians. Within cirrhosis, high diversity was related to Brazil-origin (p<0.0001), age, and cereal intake (p=0.05) while high MELD (p=0.009) and ascites (p=0.05) did the reverse. Regardless of stage, beneficial taxa/those higher with grain/yogurt intake were higher (Ruminococcaceae, Christensenellacae, Prevotellaceae), while pathobionts (Porphyromonadaceae, Sutterellaceae, Enterobacteriaceae) were lower in Brazilians. Hospitalizations: More Americans were hospitalized versus Brazil (p=0.002). On regression, MELD (p=0.001) and ascites (p=0.001) associated with higher while chocolate (p=0.03) and Brazil-origin (p=0.001) associated with lower hospitalizations with/without microbiota inclusion.

Conclusions: Brazilian cirrhotic patients follow a diet richer in cereals and yogurt, which associates with higher microbial diversity and beneficial microbiota and could contribute towards lower hospitalizations compared to a Western-diet consuming American cohort.

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