title: Fatty liver is associated with recurrent bacterial infections independent of metabolic syndrome.
abstract: BACKGROUND
  Diabetes mellitus and obesity are important components of metabolic syndrome (MetS) which are associated with infections. MetS is frequent in nonalcoholic fatty liver disease (NAFLD).
  
  
  OBJECTIVE
  The objective of this study was to examine whether patients with NAFLD are at higher risk of recurrent bacterial infections (RBIs).
  
  
  METHODS
  Two-hundred and forty-seven from 296 hospitalized NAFLD patients were assessed over a three-year period for the occurrence of RBIs and were compared with 100 age and gender-matched patients without NAFLD, who were hospitalized over the same period because of a bacterial infection. An RBI was defined as: ≥2 episodes of bacterial infections per year for a period of three consecutive years. NAFLD was diagnosed by ultrasonography. Biomarkers of inflammation, the level of oxidative stress, insulin resistance, and serum vitamin D levels were measured.
  
  
  RESULTS
  NAFLD patients had significantly more RBIs than the patients without NAFLD (22% vs. 8%; P < 0.001). Univariate analysis showed that age, BMI, male waist circumference, serum 25(OH)D, triglycerides, serum malondialdehyde, and paraoxonase-1 are associated with RBIs in NAFLD patients. Multivariate analysis showed that NAFLD (odds ratio (OR) = 3.0, 95% confidence interval (CI) = 2.6-4.2, P < 0.001), serum 25(OH)D level <20 ng/mL (OR = 2.6; 95% CI 2.4-3.1, P = 0.01), obesity (BMI >30 kg/m(2) (OR = 2.2, 95% CI 1.8-2.9, P = 0.02) were associated with RBIs, irrespective of MetS.
  
  
  CONCLUSIONS
  NAFLD is associated with increased risk of RBIs irrespective of MetS. Vitamin D insufficiency is frequent in NAFLD and is associated with increased risk of RBIs.
authors.affiliation: Department of Internal Medicine, Holy Family Hospital, P.O.B. 8, 16100 Nazareth, Israel. w.nseir@yahoo.com
authors.forename: William
authors.initials: W
authors.lastname: Nseir
authors.forename: Hussein
authors.initials: H
authors.lastname: Taha
authors.forename: Julnar
authors.initials: J
authors.lastname: Khateeb
authors.forename: Maria
authors.initials: M
authors.lastname: Grosovski
authors.forename: Nimer
authors.initials: N
authors.lastname: Assy
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D012008:Recurrence; D014808:Vitamin D Deficiency / Q000150:complications / Q000453:epidemiology