Association of Small Intestinal Bacterial Overgrowth with Nonalcoholic Fatty Liver Disease in Children: A Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Dec 2

PMID 34855819

Citations 6

Authors

Linghan Kuang

Wei Zhou

Yongmei Jiang

Affiliations

Soon will be listed here.

Abstract

It has been suggested that small intestinal bacterial overgrowth (SIBO) could cause nonalcoholic fatty liver disease (NAFLD), but this association was not examined in children by meta-analysis. This meta-analysis aimed to determine the association between SIBO and NAFLD in children. The electronic databases PubMed, Embase, and Cochrane Library were searched for studies published before April 22, 2021. The outcome was the association between SIBO and NAFLD. Three studies and 205 children were included. All three studies reported the association between SIBO and NAFLD. Children with SIBO were more likely to have NAFLD (odds ratio = 5.27, 95% confidence interval (CI): 1.66-16.68, P<0.001; I2 = 63.5%, Pheterogeneity = 0.065). When directly pooling the reported relative risks (RR) from two studies, children with NAFLD had an over 2-fold increased relative risk of developing SIBO (RR = 2.17, 05%CI: 1.66-2.82, P<0.001; I2 = 0.0%, Pheterogeneity = 0.837). This meta-analysis reports a possible association between SIBO and NAFLD in children.

Citing Articles

Web of Science-Based Visualization of Metabolic Dysfunction-Associated Fatty Liver Disease in Pediatric and Adolescent Populations: A Bibliometric Study.

Hu L, Du H, Zhou Q, Liu C, Zhang T, Yuan M Health Sci Rep. 2025; 8(2):e70409.

PMID: 39897463 PMC: 11779742. DOI: 10.1002/hsr2.70409.

Small intestinal bacterial overgrowth in chronic liver disease: an updated systematic review and meta-analysis of case-control studies.

Shah A, Spannenburg L, Thite P, Morrison M, Fairlie T, Koloski N EClinicalMedicine. 2025; 80():103024.

PMID: 39844931 PMC: 11751576. DOI: 10.1016/j.eclinm.2024.103024.

Small intestinal bacterial overgrowth and metabolic dysfunction-associated steatotic liver disease.

Wang Z, Tan W, Huang J, Li Q, Wang J, Su H Front Nutr. 2025; 11:1502151.

PMID: 39742106 PMC: 11685094. DOI: 10.3389/fnut.2024.1502151.

Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Related Diseases-Current State of Knowledge.

Roszkowska P, Klimczak E, Ostrycharz E, Raczka A, Wojciechowska-Koszko I, Dybus A Biomedicines. 2024; 12(5).

PMID: 38790992 PMC: 11117733. DOI: 10.3390/biomedicines12051030.

Epidemiology of small intestinal bacterial overgrowth.

Efremova I, Maslennikov R, Poluektova E, Vasilieva E, Zharikov Y, Suslov A World J Gastroenterol. 2023; 29(22):3400-3421.

PMID: 37389240 PMC: 10303511. DOI: 10.3748/wjg.v29.i22.3400.

References

Ghoshal U . How to interpret hydrogen breath tests. J Neurogastroenterol Motil. 2011; 17(3):312-7. PMC: 3155069. DOI: 10.5056/jnm.2011.17.3.312. View

Sachdev A, Pimentel M . Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Ther Adv Chronic Dis. 2013; 4(5):223-31. PMC: 3752184. DOI: 10.1177/2040622313496126. View

Rorato R, de Carvalho Borges B, Uchoa E, Antunes-Rodrigues J, Elias C, Elias L . LPS-Induced Low-Grade Inflammation Increases Hypothalamic JNK Expression and Causes Central Insulin Resistance Irrespective of Body Weight Changes. Int J Mol Sci. 2017; 18(7). PMC: 5535922. DOI: 10.3390/ijms18071431. View

Tilg H, Moschen A . Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology. 2010; 52(5):1836-46. DOI: 10.1002/hep.24001. View

Ludwig D . Epidemic Childhood Obesity: Not Yet the End of the Beginning. Pediatrics. 2018; 141(3). PMC: 5847089. DOI: 10.1542/peds.2017-4078. View

Ponziani F, Gerardi V, Gasbarrini A . Diagnosis and treatment of small intestinal bacterial overgrowth. Expert Rev Gastroenterol Hepatol. 2015; 10(2):215-27. DOI: 10.1586/17474124.2016.1110017. View

Bures J, Cyrany J, Kohoutova D, Forstl M, Rejchrt S, Kvetina J . Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010; 16(24):2978-90. PMC: 2890937. DOI: 10.3748/wjg.v16.i24.2978. View

Hartmann P, Schnabl B . Risk factors for progression of and treatment options for NAFLD in children. Clin Liver Dis (Hoboken). 2018; 11(1):11-15. PMC: 5881937. DOI: 10.1002/cld.685. View

Riviere A, Selak M, Lantin D, Leroy F, De Vuyst L . Bifidobacteria and Butyrate-Producing Colon Bacteria: Importance and Strategies for Their Stimulation in the Human Gut. Front Microbiol. 2016; 7:979. PMC: 4923077. DOI: 10.3389/fmicb.2016.00979. View

10.

Ghoshal U, Ghoshal U, Das K, Misra A . Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time. Indian J Gastroenterol. 2006; 25(1):6-10. View

11.

Schnabl B, Brenner D . Interactions between the intestinal microbiome and liver diseases. Gastroenterology. 2014; 146(6):1513-24. PMC: 3996054. DOI: 10.1053/j.gastro.2014.01.020. View

12.

Rezaie A, Pimentel M, Rao S . How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach. Curr Gastroenterol Rep. 2016; 18(2):8. DOI: 10.1007/s11894-015-0482-9. View

13.

Shi J, Gao F, Zhang J . Effect of Combined Live Probiotics Alleviating the Gastrointestinal Symptoms of Functional Bowel Disorders. Gastroenterol Res Pract. 2020; 2020:4181748. PMC: 7519468. DOI: 10.1155/2020/4181748. View

14.

Vos M, Abrams S, Barlow S, Caprio S, Daniels S, Kohli R . NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology.... J Pediatr Gastroenterol Nutr. 2017; 64(2):319-334. PMC: 5413933. DOI: 10.1097/MPG.0000000000001482. View

15.

Lo C, Mertz D, Loeb M . Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments. BMC Med Res Methodol. 2014; 14:45. PMC: 4021422. DOI: 10.1186/1471-2288-14-45. View

16.

Simren M, Stotzer P . Use and abuse of hydrogen breath tests. Gut. 2006; 55(3):297-303. PMC: 1856094. DOI: 10.1136/gut.2005.075127. View

17.

Rinella M . Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015; 313(22):2263-73. DOI: 10.1001/jama.2015.5370. View

18.

Brandt A, Jin C, Nolte K, Sellmann C, Engstler A, Bergheim I . Short-Term Intake of a Fructose-, Fat- and Cholesterol-Rich Diet Causes Hepatic Steatosis in Mice: Effect of Antibiotic Treatment. Nutrients. 2017; 9(9). PMC: 5622773. DOI: 10.3390/nu9091013. View

19.

Dumas M, Barton R, Toye A, Cloarec O, Blancher C, Rothwell A . Metabolic profiling reveals a contribution of gut microbiota to fatty liver phenotype in insulin-resistant mice. Proc Natl Acad Sci U S A. 2006; 103(33):12511-6. PMC: 1567909. DOI: 10.1073/pnas.0601056103. View

20.

Buzzetti E, Pinzani M, Tsochatzis E . The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016; 65(8):1038-48. DOI: 10.1016/j.metabol.2015.12.012. View