title: Intestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with liver disease severity.
abstract: BACKGROUND
  Increased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression.
  
  
  OBJECTIVE
  To investigate the prevalence of altered intestinal permeability in children with non-alcoholic fatty liver disease, and to study its potential association with the stage of liver disease.
  
  
  METHODS
  We performed a case-control study examining intestinal permeability in children using the lactulose-mannitol bowel permeability test.
  
  
  RESULTS
  Overall, 39 consecutive patients (30 males, median age 12 years) and 21 controls (14 males, median age 11.8 years) were included. The lactulose/mannitol ratio resulted impaired in 12/39 patients (31%) and none of the controls. Intestinal permeability was higher in children with non-alcoholic fatty liver disease (lactulose/mannitol ratios: 0.038±0.037 vs. 0.008±0.007, p<0.05). Within the non-alcoholic fatty liver disease group, intestinal permeability was increased in children with steatohepatitis compared to those with steatosis only (0.05±0.04 vs. 0.03 vs. 0.03, p<0.05). Pathological lactulose/mannitol ratio correlated with portal inflammation (p=0.02), fibrosis (p=0.0002), and ballooning of hepatocytes (p=0.003). Blood lipopolysaccharides levels were higher in children with steatohepatitis (2.27±0.68 vs. 2.80±0.35, p<0.05).
  
  
  CONCLUSIONS
  Intestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with the severity of the disease.
authors.affiliation: Hepato-metabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Giorgio
authors.affiliation: Clinical Division of Internal Medicine, Gastroenterology and Liver Unit, Complesso Integrato Columbus Hospital, Catholic University of Rome, Italy; Institute of Internal Medicine, Catholic University of Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.affiliation: Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Principessa
authors.affiliation: Hepato-metabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferretti
authors.affiliation: Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Villa
authors.affiliation: Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Negro
authors.affiliation: Clinical Division of Internal Medicine, Gastroenterology and Liver Unit, Complesso Integrato Columbus Hospital, Catholic University of Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Grieco
authors.affiliation: Hepato-metabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Alisi
authors.affiliation: Hepato-metabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy. Electronic address: nobili66@yahoo.it.
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
mesh_terms: D000293:Adolescent; D018988:Bacterial Translocation; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D007792:Lactulose / Q000378:metabolism; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D008353:Mannitol / Q000378:metabolism; D065626:Non-alcoholic Fatty Liver Disease / Q000473:pathology* / Q000503:physiopathology*; D010539:Permeability; D012720:Severity of Illness Index
chemical_list: D008070:Lipopolysaccharides; D008353:Mannitol; D007792:Lactulose
keywords: Intestinal permeability; Lactulose/mannitol ratio; Lipopolysaccharides; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis