الفهرس 
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Abstract
Non alcoholic fatty liver disease (NAFLD) is defined as the excessive accumulation of triglycerides in ≥5% of hepatocytes in the absence of significant alcohol consumption (less than 20 and 30 g per day in women and men, respectively), or viral, autoimmune, metabolic or drug-induced liver disease.
NAFLD has been shown to be a risk factor for the development of metabolic syndrome, type 2 diabetes, and cardiovascular diseases. NAFLD is a dynamic disease encompassing a broad clinicopathologic spectrum, starting with isolated hepatic steatosis (simple steatosis), then progressing to varying degrees of necroinflammation, and subsequently leading to fibrosis and eventually cirrhosis.
Obesity has been shown to affect almost every organ system, and is associated with cardiovascular diseases, type 2 diabetes, hypertension, and even certain cancers. Increased consumption of energy dense foods and decreased physical activity are the most important culprits implicated in the dramatic increase in obesity prevalence globally.
Gut microbiota is an assortment of microorganisms inhabiting the length and width of mammalian GIT. It is estimated that human microbiota contains as many as 1014 bacterial cells, a number that is 10 times greater than the number of human cells present in our bodies. There are more than 3 million of microbial genes in our gut microbiota, 150 times more than human genome.
The composition of gut microbiota is unique to each individual just like our (finger printing). More than 1000 different known bacterial species can be found in human gut microbiota, but only 150 to 170 predominate in any given subject. Over 99% of bacteria in the gut are anaerobe but in the cecum, aerobic bacteria reach high density.
Gut derived endotoxemia has been observed in patients with metabolic syndrome. The establishment of a connection between nutrients, immunity and the microbiota in the guts has been a complex challenge. Obesity has been related to a low level of systemic inflammation, which is also occurring in some metabolic tissues, like adipose tissue and liver.
The aim of this study is to detect possible relation of lactobacilli Acidophilus to non-alcoholic fatty liver disease in a sample of Egyptian population, as a preliminary approach to future help in the design of new interventions based on supplementation or inhibition of disease-associated metabolites tailored to the individual. In addition, fecal microbiome transplantation (FMT) is a ‘microbiome replacing’ approach that was recently found to be highly effective in drug resistant Clostridium difficile infection and potentially may be similarly efficacious in NAFLD and NASH. Taken together, deciphering and modulating treatment with probiotics, prebiotics or diet modulation.
This case control study was conducted on patients attending the Endocrine clinic at Ain Shams University hospital between March 2017 and February 2018. The study subjects were divided into 3 groups.
60 subjects who included in this study were divided as follows:
group 1: it included 20 obese subjects with non-alcoholic fatty liver (NAFLD). 10 patients were males (50.0%) and 10 patients were females (50.0%). With the mean age (34.9±7.2) years old.
group 2: it included 20 lean subjects with non-alcoholic fatty liver (NAFLD). 13 patients were males (65.0%) and 7 patients were females (35.0%). With the mean age (36.6±7.5) years old.
group 3: it included 20 healthy subjects as control group lean without fatty liver. 9 subjects were males (45.0%) and 11 subjects were females (55.0%). With the mean age (35.3±8.4) years old.
All of the study participants were subjected to full history taking, thorough clinical examination, laboratory investigations including (Serum levels of ALT, AST, GGT, HCV Ab, HBs Ag, fasting blood glucose, two hours post prandial blood glucose, glycated haemoglobin {HBA1C}, lipid profile {total cholesterol, HDL-Cholesterol, LDL-Cholesterol and fasting triglycerides} ), quantitative real time PCR for Lactobacillus Acidophilus in stool and radiological examination as abdominal ultrasound. Then the revised results were subjected to statistical analysis.
The results of our study showed:
No statistically significant difference among the study groups regarding stool Lactobacillus Acidophilus positive/negative results.
Significantly higher serum ALT & AST among NAFLD obese patients when compared to healthy control individuals.
Significantly higher total Cholesterol, triglycerides and LDL among NAFLD obese patients when compared to healthy control individuals.
Significantly higher HDL among healthy control individuals when compared with NAFLD obese and NAFLD lean groups.
Significantly higher FBG, 2hrsPPBG and HbA1c among NAFLD obese patients when compared to healthy control individuals.
Significant negative correlation between the cycle threshold PCR of lactobacillus acidophilus and serum liver enzymes ALT & AST in the control group. As the concentration of lactobacillus acidophilus increases, the ALT & AST tended to increase among the control group.
The main limitation to this study was the small number of patients and the recruitment from a limited area which might have affected the diversity of subjects and significance of results.
Although abdominal ultrasonography has low sensitivity for detecting mild NAFLD, it is the best low-cost method available that is also a non-invasive technique for detection of NAFLD. Because of ethical considerations, we did not carry out a liver biopsy (none of our patients had clinical presentation or significant elevation in liver enzymes). Moreover, our enrolled controls were selected carefully and did not show any risk factor for NAFLD development.
The use of semi-quantitative PCR technique helped in giving rough estimate for the concentration of the Lactobacillus Acidophilus between the study groups, but did not show exact numbers for the microbiome levels