Diet, Gut Dysbiosis and Liver Cirrhosis and their Influence upon Hepatic Encephalopathy

Cirrhosis is the end stage of progressive liver fibrosis, resulted from chronic inflammation and liver injury. Early identification of risk factors and appropriate treatment for hepatic decompensation is paramount for positive health outcomes. In this review study, we revisited mechanisms associated with gut dysbiosis and intestinal hyperpermeability in advanced liver disease, and further discussed nutritional strategies for the management of dysbiosis in liver cirrhosis. In gut dysbiosis, proportionally lower concentrations of bacteria belonging to beneficial taxa such as Lachnospiraceae, Clostridiales, Ruminococcaceae and Veillonellaceae and others are observed, in relation to pathogenic taxa such as Enterobacteriaceae, Bacteroidaceae and others. Cirrhotic patients present decreased bowel motility, bacterial overgrowth and increased intestinal permeability. Dysbiosis may further exacerbate such conditions due to the ability of pathogenic bacteria to adhere to the epithelium, produce endotoxin, disrupt bile acid metabolism, activate the immune system and trigger inflammation, in a vicious cycle. The triad hepatic encephalopathy – cirrhosis – gut dysbiosis is an evident entity, and primary prevention as well as management strategies for those three conditions aim strongly at improving intestinal health by focusing on nutritional interventions. High-protein diets may be recommended for cirrhosis patients, and the protein source is a key factor to consider, and so are dietary fibre and carbohydrate compositions. Attention is given to reduce saturated fat intake. Supplementation with branched-chain amino acids, probiotics and prebiotics have also shown positive results.