Probiotics for the improvement of metabolic profiles in patients with metabolic-associated fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

Abstract

ObjectiveThis meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy of probiotics in the treatment of metabolic-associated fatty liver disease (MAFLD) mainly in terms of liver function, glucose and lipid metabolism, and inflammation.MethodsRCTs were searched on PubMed, Web of Science, Embase, and the Cochrane Library until June 2022. A meta-analysis was performed on the therapeutic efficacy of probiotics on liver function, glucose and lipid metabolism, and inflammatory biomarkers by using RevMan 5.4 software.ResultsA total of 772 patients from 15 studies were included in the analysis. The methodological quality varied across studies. We found that adding probiotic therapies could reduce the levels of alanine aminotransferase [mean difference (MD): −11.76 (−16.06, −7.46), p < 0.00001], aspartate aminotransferase (MD: −9.08 (−13.60, −4.56), p < 0.0001], γ-glutamyltransferase [MD: −5.67 (−6.80, −4.54), p < 0.00001] and homeostasis model assessment–insulin resistance [MD: −0.62 (−1.08, −0.15), p = 0.01], in patients with MAFLD compared with those in control individuals. However, there was no statistically significant improvement in the levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, C-reactive protein and tumor necrosis factor α among patients with MAFLD. Subgroup analyses showed that other key factors, such as age, participants’ baseline body mass index, and the duration of intervention, may influence probiotic therapy outcomes.ConclusionThere is promising evidence that probiotic supplementation can reduce liver enzyme levels and regulate glycometabolism in patients with MAFLD. Further rigorous and long-term trials exploring these novel therapeutic perspectives are warranted to confirm these results.

Metabolic-Dysfunction-Associated Fatty Liver Disease and Gut Microbiota: From Fatty Liver to Dysmetabolic Syndrome

“…Among a total of 772 patients, the use of probiotics for therapeutic purposes could reduce the levels of alanine aminotransferase (mean difference (MD): −11.76 (−16.06, −7.46), p < 0.00001), aspartate aminotransferase (MD: −9.08 (−13.60, −4.56), p < 0.0001), γ-glutamyltransferase (MD: −5.67 (−6.80, −4.54), p < 0.00001) and homeostasis model assessment of insulin resistance (MD: −0.62 (−1.08, −0.15), p = 0.01) in patients with MAFLD, compared to control patients. Indeed, this study did not show statistical significance for levels of total cholesterol, triglycerides, low-density lipoproteins (LDL), C-reactive protein (PCR), and tumor necrosis factor-α (TNF-α) [ 95 ]. Regarding prebiotics, their use, in combination with probiotics, is recommended, as suggested by a recent review that underlines the importance of this combined approach that showed a significant reduction in the levels of hepatic steatosis, alanine aminotransferase (ALT), AST, HDL, LDL, triglyceride and cholesterol levels in 782 MAFLD patients compared to healthy controls [ 96 ].…”

Utilizing the Gut Microbiome as a Therapeutic Target for Liver Disease – Narrative Review

“…The most commonly used probiotics that tend to be effective include Lactobacillus and Bifidobacterium, along with Lactococcus, Streptococcus, Enterococcus, and Bacillus. 32 A combination of probiotics with Omega-3 has demonstrated decreases in hepatic steatosis in prospective human studies, as opposed to probiotic or Omega-3 treatment alone. Furthermore, Omega-3 treatment with probiotics has been shown to reduce hepatic de novo lipogenesis by inactivating sterol regulatory element-binding protein-1v (SREBP1v) and carbohydrate-responsive element-binding protein (ChREBP) activity and also reducing inflammation.…”

Bacillus coagulans TCI711 Supplementation Improved Nonalcoholic Fatty Liver by Modulating Gut Microbiota: A Randomized, Placebo-Controlled, Clinical Trial

“…In recent years, mounting research has focused on the gut-liver axis and found that the intestinal mucosal barrier, gut microbiota, and its metabolites are closely related to NAFLD pathogenesis [ 12 ]. Therefore, appropriate supplementation of specific probiotics can affect the liver’s metabolic function and slow down NAFLD severity [ 13 ].…”