Intestinal permeability is increased in children with non-alcoholic fatty liver disease, and correlates with liver disease severity

Background: Increased intestinal permeability seems to play a major role in non-alcoholic liver disease development and progression.

Aim: 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.