title: Multiple gut-liver axis abnormalities in children with obesity with and without hepatic involvement.
abstract: Gut-liver axis (GLA) dysfunction appears to play a role in obesity and obesity-related hepatic complications.
  
  
  
  This study sought to concurrently explore several GLA components in a paediatric obese population with/without liver disease.
  
  
  
  Thirty-two children (mean age 11.2 years) were enrolled: nine controls with normal weight and 23 patients with obesity (OB+). Of the 23 patients OB(+), 12 had not steatosis (ST-), and 11 had steatosis (ST+) (associated [n = 8] or not [n = 3] with hypertransaminasaemia [ALT +/-]). Subjects were characterized by using auxologic, ultrasonographic and laboratory parameters. A glucose hydrogen breath test was performed to test for small intestinal bacterial overgrowth, a urinary lactulose/mannitol ratio (LMR) was obtained to assess intestinal permeability, and tests for transaminases, blood endogenous ethanol, endotoxin and faecal calprotectin were also conducted.
  
  
  
  Eleven out of 23 patients OB(+) (p < 0.05) exhibited pathological (>90th percentile of the control group values) LMR, with values paralleling the grade of liver involvement (normal weight < OB[+] < OB[+]ST[+]ALT[-] < OB[+)]ST[+]ALT[+] [p < 0.05]). LMR significantly correlated with ethanolaemia (r = 0.38, p = 0.05) and endotoxaemia (r = 0.48, p = 0.015) concentrations. Increased permeability was a risk factor for the development of steatosis (p < 0.002). SIBO was present only in patients with obesity. Faecal calprotectin concentrations were within normal limits in all subjects.
  
  
  
  Increased permeability, endogenous ethanol and systemic endotoxin concentrations reflect some GLA dysfunction in obesity and its hepatic complications. Pending further results to establish their potential causative roles, the modulation of the GLA appears to represent a possible target for the prevention and treatment of these conditions.
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Guercio Nuzio
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Stasi
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pierri
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.|Laboratory of Metabolomics Theoreo, Pugliano, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Troisi
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Poeta
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bisogno
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Belmonte
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tripodi
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Di Salvio
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Massa
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Savastano
authors.affiliation: Department of Physics, University of Salerno, Fisciano, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cavallo
authors.affiliation: Laboratory, Section of Cava dei Tirreni, AOU Salerno, Salerno, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Boffardi
authors.affiliation: Institute of Nutritional Sciences, SD Model Systems of Molecular Nutrition, Friedrich-Schiller-University Jena, Jena, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Ziegenhardt
authors.affiliation: Institute of Nutritional Sciences, SD Model Systems of Molecular Nutrition, Friedrich-Schiller-University Jena, Jena, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Bergheim
authors.affiliation: Department of Pediatrics, AORN Santobono - Pausilipon, Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mandato
authors.affiliation: Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.|European Laboratory for Food Induced Intestinal Disease (ELFID), Naples, Italy.|8 AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Vajro
mesh_terms: D000293:Adolescent; D001944:Breath Tests; D002648:Child; D005260:Female; D006801:Humans; D007422:Intestines / Q000503:physiopathology*; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D063766:Pediatric Obesity / Q000150:complications / Q000503:physiopathology*; D010539:Permeability; D012307:Risk Factors
keywords: Endotoxin; NAFLD; ethanol; gut-liver axis