Influence of gut microbiota on the development and progression of nonalcoholic steatohepatitis

Eur J Nutr. 2018 Apr;57(3):861-876. doi: 10.1007/s00394-017-1524-x. Epub 2017 Sep 5.


Introduction: Nonalcoholic steatohepatitis (NASH) is characterized by the presence of steatosis, inflammation, and ballooning degeneration of hepatocytes, with or without fibrosis. The prevalence of NASH has increased with the obesity epidemic, but its etiology is multifactorial. The current studies suggest the role of gut microbiota in the development and progression of NASH. The aim is to review the studies that investigate the relationship between gut microbiota and NASH. These review also discusses the pathophysiological mechanisms and the influence of diet on the gut-liver axis.

Result: The available literature has proposed mechanisms for an association between gut microbiota and NASH, such as: modification energy homeostasis, lipopolysaccharides (LPS)-endotoxemia, increased endogenous production of ethanol, and alteration in the metabolism of bile acid and choline. There is evidence to suggest that NASH patients have a higher prevalence of bacterial overgrowth in the small intestine and changes in the composition of the gut microbiota. However, there is still a controversy regarding the microbiome profile in this population. The abundance of Bacteroidetes phylum may be increased, decreased, or unaltered in NASH patients. There is an increase in the Escherichia and Bacteroides genus. There is depletion of certain taxa, such as Prevotella and Faecalibacterium.

Conclusion: Although few studies have evaluated the composition of the gut microbiota in patients with NASH, it is observed that these individuals have a distinct gut microbiota, compared to the control groups, which explains, at least in part, the genesis and progression of the disease through multiple mechanisms. Modulation of the gut microbiota through diet control offers new challenges for future studies.

Keywords: Dysbiosis; Gut microbiota; Microbiome; Nonalcoholic fatty liver disease; Steatohepatitis.

Publication types

  • Review

MeSH terms

  • Animals
  • Bile Acids and Salts / metabolism
  • Choline / metabolism
  • Diet / adverse effects
  • Disease Progression
  • Dysbiosis / immunology
  • Dysbiosis / metabolism
  • Dysbiosis / microbiology
  • Dysbiosis / physiopathology*
  • Endotoxemia / etiology
  • Endotoxemia / immunology
  • Endotoxemia / microbiology
  • Endotoxemia / physiopathology
  • Energy Intake
  • Energy Metabolism
  • Ethanol / metabolism
  • Evidence-Based Medicine*
  • Fermentation
  • Gastrointestinal Microbiome* / immunology
  • Humans
  • Lipopolysaccharides / biosynthesis
  • Lipopolysaccharides / toxicity
  • Liver / immunology
  • Liver / metabolism
  • Liver / physiopathology*
  • Models, Biological*
  • Non-alcoholic Fatty Liver Disease / etiology*
  • Non-alcoholic Fatty Liver Disease / immunology
  • Non-alcoholic Fatty Liver Disease / microbiology
  • Non-alcoholic Fatty Liver Disease / physiopathology


  • Bile Acids and Salts
  • Lipopolysaccharides
  • Ethanol
  • Choline