Background/Aims:We aimed to analyze the efficiency of a novel treatment approach, long-term synbiotic supplementation, in addition to lifestyle changes in children with non-alcoholic fatty liver disease (NAFLD). Materials and Methods: The study included children with NAFLD (n=28) and a healthy control group (n=30). Children with NAFLD were given 1 capsule/day of synbiotics. Anthropometric parameters; biochemical analysis, including ethanol, tumor necrosis factor-α (TNF-α), total oxidant status (TOS) and anti-oxidant status (TAS), zonulin, and fecal calprotectin; and ultrasonographic examination were performed at baseline and 4 months later. Results: The grade of fatty liver was decreased (≥1 grade) in 19 of the 28 patients (67.8%) after synbiotic supplementation. Total cholesterol, low-density lipoprotein (LDL) levels, TNF-α, C-reactive protein (CRP), and ethanol were significantly decreased, and TAS levels were significantly increased at the end of treatment (p<0.05 for all). We found that the median decrease in CRP (-0.16 vs. -0.03 mg/dL, p=0.003) and LDL levels (-17 vs. -3 mg/dL, p=0.019) were higher in patients who responded to the supplementation.

or more of their initial complaints were considered as having improvement of their initial complaints. Results: At the end of treatment, the prebiotic group had significant improvements in belching-abdominal fullness (p ¼ 0.008), the probiotic group had significant improvements in abdominal fullness (p ¼ 0.016), bloating after meals (p ¼ 0.016) and constipation (p ¼ 0.031), and the synbiotic group had significant improvements in belchingabdominal fullness (p ¼ <0.001), bloating after meals (p ¼ 0.004), constipation (p ¼ 0.021) and mucus in the feces (p ¼ 0.021). The synbiotic group had a significantly higher ratio of full recovery with treatment than did the prebiotic group (39% vs. 12.5%, p ¼ 0.036). Conclusion:In conclusion, the twice-a-day administration of synbiotics, probiotics and prebiotics is safe for the treatment of children with IBS. When compared to prebiotics, the administration of synbiotics and probiotics provides significant improvements in initial complaints. Furthermore, the ratio of those with full recovery in IBS symptoms was significantly higher in the synbiotic group than in the prebiotic group; the probiotic group was not significantly different.