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. 2022 Mar 15;23(6):3167. doi: 10.3390/ijms23063167

Table 3.

Studies conducted in humans addressing the effects of different probiotics (single strain and mixtures) in NAFLD treatment (PICO format).

Reference Population Intervention Comparison Outcome
[53] 28 adults with NAFLD
20 men
8 women.		 Daily consumption
Probiotic mixture
(5 × 108 CFU):
L. bulgaricus
S. thermophilus
Treatment period: 3 months.		 Placebo. ↓ Serum ALT, AST and GGT levels.
[59] 72 obese adults with NAFLD
33 men
39 women
Age: 23–63 years old.
BMI: 25–40 kg/m2 		Daily consumption
Probiotic-enriched
yogurt (300 g/d):
L. bulgaricus
S. thermophilus
L. acidophilus
(6.46 × 106 CFU/g)
B. lactis Bb12 (4.97 × 106 CFU/g)
Treatment period: 8 weeks		 Daily consumption
Conventional yogurt
(300 g/d)
L. bulgaricus
S. thermophilus 		↓ Serum ALT and AST levels.
[54] 64 obese adolescents with NAFLD
Age: 10–18 years old
BMI >85th percentile (age and sex specific)		 Daily consumption
Probiotic mixture
(1 capsule):
L. acidophilus ATCC B3208 (3 × 109 CFU)
B. lactis DSMZ 32269 (6 × 109 CFU)
B. bifidum ATCC SD6576 (2 × 109 CFU)
L. rhamnosus DSMZ 21690 (2 × 109 CFU)
Treatment period: 12 weeks		 Placebo. ↓ Serum ALT and AST levels.
↓ Fatty liver grade (sonographic grading).
[55] 58 adult patients with NAFLD and T2DM
Age: 18–65 years old
BMI > 25 kg/m2 		Daily consumption
Probiotic mixture (1 sachet of 10 g).
Lactobacillus + Lactococcus (6 × 1010 CFU/g)
Bifidobacterium (1 × 1010 CFU/g)
Propionibacterium (3 × 1010 CFU/g)
Acetobacter (1 × 106 CFU/g)
Treatment period: 8 weeks		 Placebo. ↓ FLI and LS.
↓ Serum AST and GGT levels.
Decreased circulating levels of proinflammatory markers:
↓ Serum TNF-α and IL-6 levels.
[56] 65 obese adults with NAFLD
33 men
32 women
Age: 19–75 years old
BMI >25 kg/m2
Mean hepatic MRI-PDFF 16.2%		 Daily consumption
Probiotic mixture (containing 1 × 109 CFU/1.4 g)
L. acidophilus CBT LA1
L. rhamnosus CBT LR5 (human feces)
L. paracasei CBT LPC5 (Korean fermented food—jeotgal)
P. pentosaceus CBT SL4 (Korean fermented vegetable product—kimchi)
B. lactis CBT BL3
B. breve CBT BR3 (Korean infant feces)
Treatment period: 12 weeks		 Placebo. ↓ IHF fraction.
Modulation of gut microbiota composition:
↑ Relative abundances of
L. acidophilus
L. rhamnosus
P. pentosaceus
B. lactis
B. breve
[57] 30 adults with NAFLD:
[ALT] and [AST] >1.5-fold normal levels		 Daily consumption
Probiotic mixture
(2 capsules containing 11.25 × 1010 CFU, each)
L. paracasei DSM 24733,
L. plantarum DSM 24730
L. acidophilus
DSM 24735
L. delbrueckii subsp. Bulgaricus DSM 24734
B. longum DSM 24736
B. infantis DSM 24737
B. breve DSM 24732
S. thermophilus DSM 24731
Treatment period: 12 months		 Placebo. Improvement of liver histology:
↓ Hepatocyte ballooning.
↓ Lobular inflammation.
↓ NAS score.
↓ Serum ALT levels.
↓ Serum ALP levels.
↓ Serum pro-inflammatory
cytokines: Il-1β, IL-6 and
TNF-α.
[58] 60 adults with NAFLD 43 men
17 women
Age: 20–60 years old
BMI: 20–40 kg/m2 		Daily consumption
Probiotic mixture (1 capsule containing 5 × 109 CFU)
L. casei
L. rhamnosus
L. acidophilus
B. longum
B. breve
Treatment period: 12 weeks		 Placebo. ↓ Serum ALT, AST and GGT levels
↓ Serum ALP levels.
[60] 35 adults with NAFLD 28 men
7 women
Age: 25–70 years old
Mean BMI 32.6 ± 5.0 kg/m2 		Daily consumption
Probiotic mixture (2 sachets of VSL#3 twice daily)
S. thermophilus
B. breve
B. infantis
B. longum
L. acidophilus
L. plantarum
L. paracasei
L delbrueckii subsp. bulgaricus
Treatment period: 10 weeks		 Placebo. No significant improvements in markers of liver injury.
[61] 39 obese adults
28 men
11 women with NAFLD:
Fatty liver score >263 dB/m		 Daily consumption
Probiotic mixture (1 sachet containing 3 × 1010 CFU twice daily)
L. acidophilus BCMC 12,130 (107 mg)
L. lactis MCMC 12,451 (107 mg)
B. bifidum BCMC 02290 (107 mg)
B. infantis BCMC 02129 (107 mg)
B. longum BCMC 02120 (107 mg)
Treatment period: 6 months		 Placebo. No significant improvements
in liver fibrosis parameters or serum markers of inflammation.

ALP: alkaline phosphatase; ALT: alanine transaminase; AST: aspartate aminotransferase; BMI: body mass index; CFU: colony-forming units; FLI: fatty liver index; GGT: γ glutamyl transferase; HbA1c: glycated hemoglobin; IHF: intrahepatic fat; IL-1β: interleukin 1β; IL-6: interleukin 6; m: men; LS: liver stiffness; MRI-PDFF: magnetic-resonance-imaging-derived proton density fat fraction; NAFLD: non-alcoholic fatty liver disease; NAS: NAFLD activity score; TNF-α: tumor necrosis factor α; w: women; ↓: significant reduction; ↑: significant increase.