Fatty Liver Is Associated with Recurrent Bacterial Infections Independent of Metabolic Syndrome

Background Diabetes mellitus and obesity are important components of metabolic syndrome (MetS) which are associated with infections. MetS is frequent in nonalcoholic fatty liver disease (NAFLD). Aims The objective of this study was to examine whether patients with NAFLD are at higher risk of recurrent bacterial infections (RBIs). Methods Two-hundred and forty-seven from 296 hospitalized NAFLD patients were assessed over a three-year period for the occurrence of RBIs and were compared with 100 age and gender-matched patients without NAFLD, who were hospitalized over the same period because of a bacterial infection. An RBI was defined as: a parts per thousand yen2 episodes of bacterial infections per year for a period of three consecutive years. NAFLD was diagnosed by ultrasonography. Biomarkers of inflammation, the level of oxidative stress, insulin resistance, and serum vitamin D levels were measured. Results NAFLD patients had significantly more RBIs than the patients without NAFLD (22% vs. 8%; P < 0.001). Univariate analysis showed that age, BMI, male waist circumference, serum 25(OH)D, triglycerides, serum malondialdehyde, and paraoxonase-1 are associated with RBIs in NAFLD patients. Multivariate analysis showed that NAFLD (odds ratio (OR) = 3.0, 95% confidence interval (CI) = 2.6-4.2, P < 0.001), serum 25(OH)D level < 20 ng/mL (OR = 2.6; 95% CI 2.4-3.1, P = 0.01), obesity (BMI > 30 kg/m(2) (OR = 2.2, 95% CI 1.8-2.9, P = 0.02) were associated with RBIs, irrespective of MetS. Conclusions NAFLD is associated with increased risk of RBIs irrespective of MetS. Vitamin D insufficiency is frequent in NAFLD and is associated with increased risk of RBIs.