Role of Probiotics in the Treatment of Nonalcoholic Fatty Liver Disease: A Meta-analysis

Abstract

Aim:Despite extensive ongoing research, there is scarcity of widely accepted therapeutic options for the treatment of nonalcoholic fatty liver disease (NAFLD). Probiotics are a promising treatment option for treating NAFLD; however, their effectiveness needs to be established. Since any single randomized controlled trial (RCT) cannot establish the role of probiotics in the treatment of NAFLD, this study aims at meta-analysis of different RCTs.Materials and methods:Extensive search was done by two independent observers for RCTs studying the role of probiotics in the treatment of NAFLD. The parameters under consideration were body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), homeostatic model assessment of insulin resistance (HOMA-IR), serum triglycerides (TGs), and ultrasonographic grades of fatty liver. Jadad scale was used to select the articles for meta-analysis. Heterogeneity in the results was evaluated using chi-square test and I2. Significant heterogeneity in the results was decided based on p-value < 0.05 and the corresponding I2 close to 0%.Results:Seven studies qualified for meta-analysis. Use of probiotics significantly caused reduction in BMI (p < 0.0001), ALT (p < 0.0001), AST (< 0.0001), HOMA-IR (p = 0.006), and ultrasonographic grade of fatty liver (p = 0.0051). Heterogeneity in other parameters was contributed mainly by couple of previous studies.Conclusion:Meta-analysis shows that variety of parameters has significant improvement after probiotic treatment in different RCTs. However, the magnitude of improvement is not uniform across studies due to varying strains, dose patterns, and treatment duration. In future, probiotics remain a promising option for treating NAFLD.How to cite this article: Lavekar AS, Raje DV, Manohar T, Lavekar AA. Role of Probiotics in the Treatment of Nonalcoholic Fatty Liver Disease: A Meta-analysis. Euroasian J Hepato-Gastroenterol 2017;7(2):130-137.

Effect of probiotic supplementation on liver function and lipid status in rats [pdf]

“…In our study we observed a significantly lower ALT serum concentration in the group receiving a higher dose of probiotic compared to the control group. The results of our study are in line with recent meta-analysis of 7 human double-blinded RCTs and comparative studies performed by Lavekar et al (2017), who reported a significant reduction in blood ALT activity after probiotic supplementation in the period ranging from 2 to 7 months. Moreover, the meta-analysis of Lavekar et al (2017) has confirmed the decrease in BMI and blood AST concentration after a probiotic is supplied.…”

“…The results of our study are in line with recent meta-analysis of 7 human double-blinded RCTs and comparative studies performed by Lavekar et al (2017), who reported a significant reduction in blood ALT activity after probiotic supplementation in the period ranging from 2 to 7 months. Moreover, the meta-analysis of Lavekar et al (2017) has confirmed the decrease in BMI and blood AST concentration after a probiotic is supplied. Supplementation with Lactobacillus bulgaricus and Streptococcus thermophilus have been shown to reduce not only ALT and AST, but also the gamma-glutamyltransferase (GGT) serum level in patients with NAFLD (Aller et al, 2011).…”

“…To sum up this area of our study, it can be stated that multispecies probiotic supplementation beneficially modulate the CV Sharma et al (2016) state that probiotic interventions show no significant effect on TG blood levels. Similarly, a meta-analysis of Lavekar et al (2017) published as recently as in 2017 failed to prove the influence of probiotic supplementation in the range of TG metabolism. However, Lavekar et al place emphasis on the high heterogeneity of analyzed trials in this field.…”

What are the main areas of focus to prevent or treat non‐alcoholic fatty liver disease?

“…The authors also noted that BMI, glucose, and low‐density lipoprotein did not improve after probiotic treatment . Recently, several meta‐analyses have evaluated the effects of probiotics on liver histology . The authors did report the favorite effects of probiotic in NASH.…”

“…At present, however, there is no uniformity in the outcomes assessed. Moreover, it remains to be elucidated whether the type of microbial therapy, the dose used of treatment, and the duration of therapy affect outcomes or not …”