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Interaction of Microbiome, Diet and Hospitalizations between Brazilian and American Patients with Cirrhosis

M R Alvares-da-Silva et al, 2021.
Clinical Gastroenterology and Hepatology.
April 4, 2021



Gut microbiota are affected by diet, country and affects outcomes in cirrhosis. Western diets are associated with dysbiosis. Comparisons with other diets is needed.


Compare cirrhosis patients from USA to Brazil with respect to diet, microbiota, and impact on hospitalizations.


Healthy controls and compensated/decompensated outpatients with cirrhosis from USA and Brazil underwent dietary recall and stool for 16S rRNA sequencing. Demographics, medications/cirrhosis details were compared within/between countries. Patients with cirrhosis were followed for 90-day hospitalizations. Regression for Shannon diversity was performed within cirrhosis. Regression for hospitalizations adjusting for clinical and microbial variables was performed.


MELD, diabetes, ascites, albumin was similar, but more Americans were men, had higher hepatic encephalopathy and alcohol/hepatitis C etiology with lower NAFLD than Brazilians. Brazilians had higher cereal, rice, and yogurt intake versus USA. As disease progressed cereals, rice/beans, coffee, and chocolate consumption reduced. Microbial diversity was higher in Brazilians. Within cirrhosis, high diversity was related to Brazil-origin (p<0.0001), age, and cereal intake (p=0.05) while high MELD (p=0.009) and ascites (p=0.05) did the reverse. Regardless of stage, beneficial taxa/those higher with grain/yogurt intake were higher (Ruminococcaceae, Christensenellacae, Prevotellaceae), while pathobionts (Porphyromonadaceae, Sutterellaceae, Enterobacteriaceae) were lower in Brazilians. Hospitalizations: More Americans were hospitalized versus Brazil (p=0.002). On regression, MELD (p=0.001) and ascites (p=0.001) associated with higher while chocolate (p=0.03) and Brazil-origin (p=0.001) associated with lower hospitalizations with/without microbiota inclusion.


Brazilian cirrhotic patients follow a diet richer in cereals and yogurt, which associates with higher microbial diversity and beneficial microbiota and could contribute towards lower hospitalizations compared to a Western-diet consuming American cohort.

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