{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:37:32Z","timestamp":1792795052600,"version":"4.5.0"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2018,11,18]],"date-time":"2018-11-18T00:00:00Z","timestamp":1542499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004442","name":"NCN","doi-asserted-by":"publisher","award":["No. N404 150539"],"award-info":[{"award-number":["No. N404 150539"]}],"id":[{"id":"10.13039\/501100004442","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>(1) Introduction: Zonulin (ZO) has been proposed as a marker of intestinal permeability. Only a few studies have analyzed to date how diet influences the serum concentration of ZO among patients with non-alcoholic fatty liver disease (NAFLD). We performed a six-month dietetic intervention to evaluate the association between fiber intake and ZO concentration in 32 individuals with NAFLD. (2) Methods: Fiber content in the diet was estimated by Food Frequency Questionnaire (FFQ) and by analyzing 72-h nutritional diaries. ZO concentrations in serum were measured before and after the intervention by immunoenzymatic assay (ELISA). Fatty liver was quantified using the Hamaguchi score before and after the dietetic intervention. (3) Results: During the intervention, the dietary fiber intake increased from 19 g\/day to the 29 g\/day concomitant with an increase in the frequency of fiber consumption. All patients experienced significant (all p &lt; 0.05) improvements in serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGTP) activities. We also detected decreased serum triglycerides (p = 0.036), homeostatic model assessment insulin resistance (HOMA-IR (p = 0.041) and insulin content (p = 0.34), and improvement of fatty liver status according to the Hamaguchi score (p = 0.009). ZO concentration in serum decreased by nearly 90% (7.335 \u00b1 13.492 vs. 0.507 \u00b1 0.762 ng\/mL, p = 0.001) and correlated with the amount of dietary fiber intake (p = 0.043) as well as the degree of fatty liver (p = 0.037). (4) Conclusion: Increasing nutritional fiber results in reduced serum ZO levels, reduced liver enzymes and improved hepatic steatosis in patients with NAFLD, possibly by altering intestinal permeability. Increased dietary fiber intake should be recommended in patients with NAFLD.<\/jats:p>","DOI":"10.3390\/nu10111793","type":"journal-article","created":{"date-parts":[[2018,11,21]],"date-time":"2018-11-21T11:23:27Z","timestamp":1542799407000},"page":"1793","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Gut Permeability Might be Improved by Dietary Fiber in Individuals with Nonalcoholic Fatty Liver Disease (NAFLD) Undergoing Weight Reduction"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0113-0777","authenticated-orcid":false,"given":"Marcin","family":"Krawczyk","sequence":"first","affiliation":[{"name":"Department of Medicine II, Saarland University Medical Center, Saarland University, 66421 Homburg, Germany"},{"name":"Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Maciejewska","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-3312","authenticated-orcid":false,"given":"Karina","family":"Ryterska","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4560-7741","authenticated-orcid":false,"given":"Maja","family":"Czerwi\u0144ka-Rogowska","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Jamio\u0142-Milc","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3430-9079","authenticated-orcid":false,"given":"Karolina","family":"Skonieczna-\u017bydecka","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Milkiewicz","sequence":"additional","affiliation":[{"name":"Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery of the Medical University of Warsaw, 02-097 Warsaw, Poland"},{"name":"Translational Medicine Group, Pomeranian Medical University, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Raszeja-Wyszomirska","sequence":"additional","affiliation":[{"name":"Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery of the Medical University of Warsaw, 02-097 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4009-1977","authenticated-orcid":false,"given":"Ewa","family":"Stachowska","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Human Nutrition, Pomeranian Medical University, 71-210 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1016\/j.bbamcr.2017.03.007","article-title":"Disruption of the epithelial barrier during intestinal inflammation: Quest for new molecules and mechanisms","volume":"7","author":"Lechuga","year":"2017","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.yexcr.2017.03.036","article-title":"Contributions of intestinal epithelial barriers to health and disease","volume":"358","author":"Choi","year":"2017","journal-title":"Exp. Cell Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1271\/bbb.90730","article-title":"Interaction between food substances and the intestinal epithelium","volume":"74","author":"Shimizu","year":"2010","journal-title":"Biosci. Biotechnol. Biochem."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.burns.2003.09.032","article-title":"Effects of enteral supplementation with glutamine granules on intestinal mucosal barrier function in severe burned patients","volume":"30","author":"Peng","year":"2004","journal-title":"Burns"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.3748\/wjg.v9.i6.1327","article-title":"Effects of glutamine on intestinal permeability and bacterial translocation in TPN-rats with endotoxemia","volume":"9","author":"Ding","year":"2003","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1271\/bbb.68.59","article-title":"Isolation of tryptophan as an inhibitor of ovalbumin permeation and analysis of its suppressive effect on oral sensitization","volume":"68","author":"Watanabe","year":"2004","journal-title":"Biosci. Biotechnol. Biochem."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1017\/S0007114510001698","article-title":"The casein peptide Asn-Pro-Trp-Asp-Gln enforces the intestinal tight junction partly by increasing occludin expression in Caco-2 cells","volume":"104","author":"Yasumatsu","year":"2010","journal-title":"Br. J. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1271\/bbb.62.1819","article-title":"Effects of beta-lactoglobulin on the tight-junctional stability of Caco-2-SF monolayer","volume":"62","author":"Hashimoto","year":"1998","journal-title":"Biosci. Biotechnol. Biochem."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00018-012-1070-x","article-title":"Regulation of intestinal epithelial permeability by tight junctions","volume":"70","author":"Suzuki","year":"2013","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.3390\/nu7031565","article-title":"Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity","volume":"7","author":"Hollon","year":"2015","journal-title":"Nutrients"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1054\/clnu.2001.0430","article-title":"Effect of eicosapentaenoic acid (EPA) on tight junction permeability in intestinal monolayer cells","volume":"20","author":"Usami","year":"2001","journal-title":"Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/S0899-9007(02)00927-9","article-title":"Effect of gamma-linolenic acid or docosahexaenoic acid on tight junction permeability in intestinal monolayer cells and their mechanism by protein kinase C activation and\/or eicosanoid formation","volume":"19","author":"Usami","year":"2003","journal-title":"Nutrition"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17107","DOI":"10.3748\/wjg.v20.i45.17107","article-title":"Increased circulating zonulin in children with biopsy-proven nonalcoholic fatty liver disease","volume":"20","author":"Pacifico","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1749-6632.2012.06538.x","article-title":"Zonulin, regulation of tight junctions, and autoimmune diseases","volume":"1258","author":"Fasano","year":"2012","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ha\u0142asa, M., Maciejewska, D., Ba\u015bkiewicz-Ha\u0142asa, M., Machali\u0144ski, B., Safranow, K., and Stachowska, E. (2017). Oral Supplementation with Bovine Colostrum Decreases Intestinal Permeability and Stool Concentrations of Zonulin in Athletes. Nutrients, 9.","DOI":"10.3390\/nu9040370"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2016). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol., 64, 1388\u20131402.","DOI":"10.1016\/j.jhep.2015.11.004"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Estes, C., Anstee, Q.M., Arias-Loste, M.T., Bantel, H., Bellentani, S., Caballeria, J., Colombo, M., Craxi, A., Crespo, J., and Day, C.P. (2018). Modeling NAFLD Disease Burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016\u20132030. J. Hepatol, in press.","DOI":"10.1016\/j.jhep.2018.05.036"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1038\/nature10809","article-title":"Inflammasome-mediated dysbiosis regulates progression of NAFLD and obesity","volume":"482","author":"Elinav","year":"2012","journal-title":"Nature"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/S1499-3872(17)60019-5","article-title":"Gut microbiota dysbiosis in patients with non-alcoholic fatty liver disease","volume":"16","author":"Shen","year":"2017","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5314","DOI":"10.2174\/1381612811319290011","article-title":"Gut-liver axis and microbiota in NAFLD: Insight pathophysiology for novel therapeutic target","volume":"19","author":"Miele","year":"2013","journal-title":"Curr. Pharm. Des."},{"key":"ref_21","first-page":"43","article-title":"Evaluation of circulating zonulin as a potential marker in the pathogenesis of nonalcoholic fatty liver disease","volume":"69","author":"Hendy","year":"2017","journal-title":"Metabolism"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1515\/CCLM.2007.142","article-title":"Evaluation of genetic predisposition to insulin resistance by nutrient-induced insulin output ratio (NIOR)","volume":"45","author":"Wybranska","year":"2007","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Poeta, M., Pierri, L., and Vajro, P. (2017). Gut-Liver Axis Derangement in Non-Alcoholic Fatty Liver Disease. Children, 4.","DOI":"10.3390\/children4080066"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/apt.14119","article-title":"Significant positive association of endotoxemia with histological severity in 237 patients with non-alcoholic fatty liver disease","volume":"46","author":"Pang","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1136\/gutjnl-2014-308379","article-title":"Insulin resistance alters hepatic ethanol metabolism: Studies in mice and children with non-alcoholic fatty liver disease","volume":"65","author":"Engstler","year":"2016","journal-title":"Gut"},{"key":"ref_26","unstructured":"(2016, November 02). QuickCalcs. Available online: https:\/\/www.graphpad.com\/quickcalcs\/randomselect2."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Stachowska, E., Ryterska, K., Maciejewska, D., Banaszczak, M., Milkiewicz, P., Milkiewicz, M., Gutowska, I., Ossowski, P., Kaczorowska, M., and Jamio\u0142-Milc, D. (2016). Nutritional Strategies for the Individualized Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) Based on the Nutrient-Induced Insulin Output Ratio (NIOR). Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17071192"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1111\/j.1572-0241.2007.01526.x","article-title":"The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation","volume":"102","author":"Hamaguchi","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_29","unstructured":"Laskowski, W. (2015). Warto\u015b\u0107 Od\u017cywcza Diety Polak\u00f3w Oraz jej Zmiany, Wolska-Adamczyk, WSIiZ. Wsp\u00f3\u0142czesne Kierunki Dzia\u0142a\u0144 Prozdrowotnych, red. A."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3945\/ajcn.116.131110","article-title":"Gut permeability is related to body weight, fatty liver disease, and insulin resistance in obese individuals undergoing weight reduction","volume":"105","author":"Louis","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Cantero, I., Abete, I., Monreal, J.I., Martinez, J.A., and Zulet, M.A. (2017). Fruit Fiber Consumption Specifically Improves Liver Health Status in Obese Subjects under Energy Restriction. Nutrients, 9.","DOI":"10.3390\/nu9070667"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1038\/nrgastro.2016.3","article-title":"Management of NAFLD: A stage-based approach","volume":"13","author":"Rinella","year":"2016","journal-title":"Nat. Rev. Gastroenterol. Hepatol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/11\/1793\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:30:27Z","timestamp":1760196627000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/11\/1793"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,18]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,11]]}},"alternative-id":["nu10111793"],"URL":"https:\/\/doi.org\/10.3390\/nu10111793","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,18]]}}}