Fredrik Bäckhed is one of the Co-authors of this article were it is concluded that the human gut microbiota produces large amounts of ethanol that might be clinically relevant for the pathogenesis of NAFLD. Ethanol production during an MMT should be considered as a noninvasive diagnostic approach for the detection of gut microbiota producing high levels of ethanol and NAFLD risk. In our prospective cohort, high postprandial plasma ethanol concentrations correlated particularly with high relative fecal abundance of lactic acid bacteria. Clinical trials targeting the gut microbiome have not yielded any meaningful outcome in NAFLD thus far. To what extent persistent endogenous ethanol production is causally involved in the highly complex pathogenesis of NAFLD, where a combination of environmental factors, genetic variants, obesity and disturbed lipid homeostasis interact, remains to be elucidated. Nevertheless, our findings suggest that further attention aiming to target the gut microbiota to reduce ethanol production and thereby lower additional risk for NAFLD is justified.

To the full article in Nature Medicine