GUT-LIVER AXIS IN OVERNUTRITION AND MALNUTRITION IN CHILDREN

Non-alcoholic fatty liver disease (NAFLD), which is the most common liver disease in adults, is now becoming increasingly common in children as well. It is usually associated with obesity and is considered as a hepatic manifestation of the metabolic syndrome. Studies of the intestinal microbiota (IMB) and its metabolites have confirmed the association of the development of NAFLD with intestinal dysbiosis, increased permeability of the intestinal barrier, endotoxemia, and chronic inflammation, which formed the basis of the concept of the gut-liver axis. But in recent years there has been evidence linking malnourished liver steatosis (kwashiorkor and micronutrient deficiencies) with impaired IMB. Changes in the spectrum of intestinal metabolites, the ratio of primary and secondary bile acids, an increase in the permeability of the intestinal barrier, oxidation products turned out to be similar in obesity and malnutrition, which made it possible to put forward a general strategy for the prevention and treatment of NAFLD with undernutrition and overnutrition, which is based on a combination of dietary correction and exposure on the microbiota with pro- and prebiotics.