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: ≤2 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.