The percentage of Bacteroidetes was significantly lower in patients with NASH, compared to both SS and HC (Fig. 2). There were no differences between the groups in the percentages of the other microorganisms assessed. Exploring for potential relationships between dietary intake and bacteria counts, we found no statistically significant correlations between total caloric intake, percentage fat or carbohydrate consumption, and fecal Bacteroidetes, C. leptum, C. coccoides, bifidobacteria, or E. coli (P > 0.05). Performing the same correlations for the NAFLD cohort only (SS and NASH combined), there was a statistically significant negative association between total

daily caloric intake Venetoclax manufacturer and fecal Bacteroidetes counts (Spearman r = −0.43,

P = 0.038). Taking into consideration that BMI and percentage of fat intake could be contributing to the association between the percentage of Bacteroidetes and NASH, ANCOVA was performed to control for these potential confounders. There was an independent association between the percentage of Bacteroidetes and the presence of NASH (P = 0.002; 95% confidence interval [CI] = −0.06 to −0.02). This was not the case with C. coccoides, which was no longer associated with NASH once BMI AT9283 solubility dmso and percentage fat intake were taken into account (P > 0.05). We also assessed whether the percentage of Bacteroidetes was associated with IR, controlling for BMI. Baf-A1 order There was a trend (r = −0.31; P = 0.06) towards a negative association between the percentage of Bacteroidetes and HOMA-IR. To our knowledge, this is the first study assessing the IM of adults with nonexperimental NAFLD and specifically comparing the IM composition of subjects classified as HC, SS, or NASH based on histological data. We found a lower relative abundance of Bacteroidetes in NASH, which was independent

of BMI and energy intake from fat in the diet. The importance of classifying patients based on liver histology is significant, as one of the most challenging aspects in the pathophysiology of NAFLD is understanding the differences between mechanisms causing simple hepatic steatosis versus those that lead to steatohepatitis. Since bacteria are known to play a pathogenetic role in the development of inflammation, comparisons between all groups (HC, SS, and NASH) allow for further elucidation of the effects of the IM on the liver. Along with Firmicutes, Bacteroidetes comprise the majority of the human IM.36, 37 In our cohort, the relative abundance of Bacteroidetes in the stool was lower in NASH compared to both SS and HC. This finding is in agreement with previously published literature in the field of obesity that has demonstrated lower Bacteroidetes in patients with higher BMI.9, 37 The novelty of our study is the suggestion of a BMI-independent association between Bacteroidetes and liver disease state. Interestingly, our findings contrast those of Zhu et al.