New review investigates the efficacy of probiotics, prebiotics, and synbiotics in NAFLD

Non-alcoholic fatty liver disease (NAFLD) is an increasing epidemic in the U.S. and the rest of the world. It is the leading cause of abnormal liver enzymes and is associated with diabetes and obesity.

At this time there are few guidelines for diagnostic and follow up methods and limited proven treatment options. Previous research of pharmacological agents to treat nonalcoholic fatty liver disease were performed with poor results.

Insulin resistance is one of the key factors in the development of NAFLD, however, the gut-liver axis plays a significant contribution as well. Gut dysbiosis and intestinal hyperpermeability lead to liver damage by proinflammatory responses.

According to a review published last week in BMC Gastroenterology, researchers investigated the effect of probiotics, prebiotics, and synbiotics in nonalcoholic fatty liver disease.

This review analyzed 34 randomized controlled trials including 12,682 patients with NALFD. The studies were conducted through March 2024 with a duration between 4 weeks and 48 weeks. These patients were diagnosed with ultrasound and/or biopsy. The research team observed that probiotics, prebiotics, and synbiotics supplementation improved not only liver histology and liver function but also triglycerides levels and body mass index (BMI). In addition, they significantly decreased hs-CRP and TNF-a levels.

Overall, supplementation with probiotic, prebiotic, or synbiotics had a positive effect on reducing liver enzymes, lipid profiles, and inflammatory cytokines in patients with NAFLD.

The meta-analysis revealed probiotics, prebiotics, and synbiotics supplementation may reduce BMI, liver injury, lipid profiles, and inflammatory factors in NAFLD patients. Probiotics supplementation had a positive effect on liver injury, including hepatic fibro­sis, AST, ALT, and ALP level. Prebiotic supplementation had a lowering effect on total cholesterol, triglycerides, and LDL cholesterol levels.

Several studies have assessed synbiotics on hepatic steatosis, fibrosis, and liver stiffness. Ultrasound imaging assessing these parameters have shown positive clinical outcomes with synbiotics. There has also been some novel MRI testing that has demonstrated similar beneficial effects of synbiotic supplementation.

Synbiotics restore the gastrointestinal barrier function, modulate the immune system, and inhibit the proliferation of harmful bacteria. Synbiotics have been shown to reduce liver fat and improve liver enzymes. Synbiotics are likely most effective by preventing bacterial translocation and reducing the effects of the intestinal microbiota on the liver.

These individuals have established disease and increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to mitigate to help reduce the progression and improve liver function in patients with NAFLD.

Other nutrients to consider include, delta and gamma tocotrienols, fish oil, carnitine, coenzyme Q10, berberine, and milk thistle.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Pan Y, et al. (2024). Efficacy of probiotics, prebiotics, and synbiotics on liver enzymes, lipid profiles, and inflammation in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials. BMC Gastroenterol 24(1):283. doi: 10.1186/s12876-024-03356-y.

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