Table 2.
Summary of recent meta-analysis of RCTs with probiotics/synbiotics therapy for NAFLD/NASH patients.
| Study | Population | Study Period | Conclusions |
|---|---|---|---|
| Loman et al. [114], 2018 | Included 25 studies (most are RCT): Among them, 9 studies used prebiotics, 11 studies used probiotics, and 7 studies used synbiotics. 1309 patients were included. | Up to December 14, 2017 | Microbial therapies significantly reduced AST and ALT, but not CRP. The results of serum cholesterol and LDL-C are mixed among prebiotics, probiotics, and synbiotics. |
| Khan et al. [115], 2019 | Included 12 probiotics/synbiotics RCTs for NAFLD. 748 patients were included. | Up to June 10, 2018 | Probiotics/synbiotics were associated with a significant improvement in ALT, AST, and liver fibrosis score graded by fibroscan. There was a reduction in CRP with synbiotics. The TNF-α, LDL-C, TG, and TC significantly improved with synbiotics but not with probiotics in a subgroup analysis. There were no significant changes in HDL-C, HOMA-IR, or FBS in either group. |
| Koutnikova et al. [116], 2019 | Included 105 articles with 111 RCTs representing 6826 subjects (includes metabolic syndrome, type II DM, and NAFLD patients). Among them, about 658 patients had NAFLD. | January 1990 to June 2018 | In subjects with fatty liver diseases, probiotics reduced AST and ALT, but not GGT. |
| Liu et al. [117], 2019 | Included 15 probiotics and synbiotic RCTs, involving 782 patients with NAFLD. | Up to April 2018 | Probiotics and synbiotics supplementation could significantly improve AST, ALT, TG, TC, HDL-C, LDL-C, homeostasis model assessment-insulin resistance, TNF-α, liver steatosis, and liver stiffness. However, probiotics and synbiotics could not ameliorate BMI, waist circumference, or FBS. |
| Sharpton et al. [118], 2019 | Included 21 RCTs (1252 participants) with NAFLD. 9 trials evaluated probiotics and 12 trials evaluated synbiotics. | January 1, 2005 to December 1, 2018 | Probiotics/synbiotics could improve AST and ALT. Probiotics/synbiotics were also associated with hepatic steatosis improvement when graded with ultrasound. Last, probiotics/synbiotics were associated with liver stiffness improvement when measured by elastography, although analyses showed heterogeneity. Probiotics, but not synbiotics, were associated with a significant reduction in body mass index. |
NAFLD: Non-alcoholic fatty liver disease;DM: diabetes mellitus; ALT: alanine transaminase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; TC: total cholesterol; TG: triglyceride; FBS: fasting serum glucose; BMI: body mass index; CRP: C reactive protein; TNF-α: tumor necrosis factor-alfa; HOMA-IR: homeostasis model assessment of insulin resistance.