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VOLUME 7 , ISSUE 2 ( July-December, 2017 ) > List of Articles

ORIGINAL ARTICLE

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

Anurag S Lavekar, Dhananjay V Raje, Amarja A Lavekar

Citation Information : Lavekar AS, Raje DV, Lavekar AA. Role of Probiotics in the Treatment of Nonalcoholic Fatty Liver Disease: A Meta-analysis. Euroasian J Hepatogastroenterol 2017; 7 (2):130-137.

DOI: 10.5005/jp-journals-10018-1233

License: CC BY 3.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2017; The Author(s).


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.


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  1. Non-alcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology 2006 Feb;43(2 Suppl 1):S99-S112.
  2. Non-obese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology 2010 May;51(5):1593-1602.
  3. Non-alcoholic fatty liver disease in a rural, physically active, low income population in Sri Lanka. BMC Res Notes 2011 Nov;4:513.
  4. Non-alcoholic fatty liver disease prevalence and associated risk factors—a study from rural sector of Maharashtra. Trop Gastroenterol 2015 Jan-Mar;36(1):25-30.
  5. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomized trials. Diabetologia 2012 Apr;55(4):885-904.
  6. Pharmacological interventions for nonalcoholic fatty liver disease in adults and in children: a systematic review. J Pediatr Gastroenterol Nutr 2009 May;48(5):587-596.
  7. ; Friedman, LS.; Brandt, LJ. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th ed. Chapter 87. Philadelphia (PA): Elsevier Saunders; 2016. p. 1437.
  8. Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease. Hepatology 2003 Feb;37(2):343-350.
  9. Probiotics improve high fat diet-induced hepatic steatosis and insulin resistance by increasing hepatic NKT cells. J Hepatol 2008 Nov;49(5):821-830.
  10. Probiotics reduce the inflammatory response induced by a high-fat diet in the liver of young rats. J Nutr 2009 May;139(5):905-911.
  11. ; Friedman, LS.; Brandt, LJ. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th ed. Chapter 2. Philadelphia (PA): Elsevier Saunders; 2016. p. 30.
  12. Probiotics and synbiotics may improve liver aminotransferases levels in non-alcoholic fatty liver disease patients. Ann Hepatol 2014 Sep-Oct;13(5):482-488.
  13. Effects of Lactobacillus rhamnosus Strain GG in pediatric obesity-related liver disease. J Pediatr Gastroenterol Nutr 2011 Jun;52(6):740-743.
  14. Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial. Eur Rev Med Pharmacol Sci 2011 Sep;15(9):1090-1095.
  15. Bifidobacterium longum with fructo-oligosaccharides in patients with non-alcoholic steatohepatitis. Dig Dis Sci 2012 Feb;57(2):545-553.
  16. Treatment of nonalcoholic steatohepatitis with probiotics. A proof-of-concept study. Ann Hepatol 2013 Mar-Apr;12(2):256-262.
  17. Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized clinical trial. J Prev Med 2013 May;4(5):531-537.
  18. Randomised clinical trial: the beneficial effects of VSL#3 in obese children with non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2014 Jun;39(11):1276-1285.
  19. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. J Clin Nutr 2014 Mar;99(3):535-542.
  20. Effects of probiotics on nonalcoholic fatty liver disease: a meta-analysis. World J Gastroenterol 2013 Oct;19(40):6911-6918.
  21. Gut-liver axis and probiotics: their role in non-alcoholic fatty liver disease. World J Gastroenterol 2014 Nov;20(42):15518-15531.
  22. Gut-liver axis: the impact of gut microbiota on non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2012 Jun;22(6):471-476.
  23. Gut-liver axis and microbiota in NAFLD: insight pathophysiology for novel therapeutic target. Curr Pharm Des 2013;19(29):5314-5324.
  24. Microbiota and gut-liver axis: their influences on obesity and obesity-related liver disease. J Pediatr Gastroenterol Nutr 2013 May;56(5):461-468.
  25. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology 2002 Nov;123(5):1705-1725.
  26. Biochemical analysis of hepatic lipid in alcoholic and diabetic and control subjects. Clin Sci (Lond)1983 Dec;65(6):645-652.
  27. Protocol for measurement of liver fat by computed tomography. J Appl Physiol (1985) 2006 Mar;100(3):864-868.
  28. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001 Jan;21(1):17-26.
  29. Abdominal ultrasound for diagnosis of nonalcoholic fatty liver disease (NAFLD). AM J Gastroenterol 2007 Dec;102(12):2216-2217.
  30. Oral probiotic microcapsule formulation ameliorates non-alcoholic fatty liver disease in Bio F1B Golden Syrian hamsters. PLoS One 2013 Mar;8:e58394.
  31. Effects of probiotics on methionine choline deficient diet-induced steatohepatitis in rats. Turk J Gastroenterol 2012 Apr;23(2):110-121.
  32. Protective effects of Lactobacillus paracasei F19 in a rat model of oxidative and metabolic hepatic injury. Am J Physiol Gastrointest Liver Physiol 2010 Sep;299(3):G669-G676.
  33. al. Canani RB, D'Agostino G, Di Costanzo M, Canani RB, Calignano A, et al. Effects of a Lactobacillus paracasei B21060 based synbiotic on steatosis, insulin signaling and toll-like receptor expression in rats fed a high-fat diet. J Nutr Biochem 2014 Jan;25(1):81-90.
  34. Butyrate-producing probiotics reduce nonalcoholic fatty liver disease progression in rats: new insight into the probiotics for the gut-liver axis. PLoS One 2013 May;8:e63388.
  35. Anti-inflammatory effect of lactobacilli bacteria on HepG2 cells is through cross-regulation of TLR4 and NOD2 signaling. J Funct Foods 2013 Apr;5:820-828.
  36. Effects of probiotic (Primalac 454) on nonalcoholic fatty liver disease in broilers. Revue Méd Vét 2011 Jul;7:371-376.
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