Mechanisms behind the Role of SIBO in Non-Alcoholic Fatty Liver Disease: An Interplay between Liver, Gut Microbiota and Nutrition

Nonalcoholic fatty liver disease (NAFLD) is known as the leading cause of chronic liver disease in both children and adults. Increasing evidence suggests that dysbiosis of the intestinal microbiota plays a key role in the regulation of various metabolic and inflammatory pathways, which may result in the development of NAFLD. When normal liver physiology is impaired, gut-derived factors may lead to increased tissue damage and inflammation. Small intestinal bacterial overgrowth (SIBO) is defined as a condition in which a large amount of intestinal bacteria are present in the small intestine. The permeability of the intestinal barrier increases with SIBO, resulting in an increase in bacterial translocation and endotoxemia. SIBO is assumed to play a critical role in the development and progression of NAFLD. Therefore, this review focuses on the mechanisms in which SIBO may play a role in NAFLD and possible nutritional management strategies such as a low FODMAP diet, probiotics and prebiotics targeting SIBO and NAFLD.