Many studies have associated altered intestinal bacterial communities and non-alcoholic fatty liver disease, but the putative effects are inconclusive. The purpose of this network meta-analysis (NMA) was to evaluate the effects of probiotics, prebiotics, and synbiotics on non-alcoholic fatty liver disease through randomised intervention trials. Literature searches were performed until March 2020. For each outcome, a random NMA was performed, the surface under the cumulative ranking curve (SUCRA) was determined. A total of 22 randomised trials comparing prebiotic, probiotic, and synbiotic treatments included 1301 participants. Considering all seven results (aspartate aminotransferase, alanine aminotransferase, body mass index, weight, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) together, the highest SUCRA values are probiotics (94%), synbiotics (61%) and prebiotics (56%), respectively. NMA results provide evidence that probiotics, prebiotics, and synbiotics can alleviate non-alcoholic fatty liver disease. However, due to the lack of high-quality randomised trials, this research also has some limitations.
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Abdel Monem, S.M., 2017. Probiotic therapy in patients with nonalcoholic steatohepatitis in Zagazig university hospitals. Euroasian Journal of Hepato-Gastroenterology 7: 101-106. https://doi.org/10.5005/jp-journals-10018-1226
Ahn, S.B., Jun, D.W., Kang, B.K., Lim, J.H., Lim, S. and Chung, M.J., 2019. Randomized, double-blind, placebo-controlled study of a multispecies probiotic mixture in nonalcoholic fatty liver disease. Scientific Reports 9: 5688. https://doi.org/10.1038/s41598-019-42059-3
Alisi, A., Bedogni, G., Baviera, G., Giorgio, V., Porro, E., Paris, C., Giammaria, P., Reali, L., Anania, F. and Nobili, V., 2014. Randomised clinical trial: the beneficial effects of VSL#3 in obese children with non-alcoholic steatohepatitis. Alimentary Pharmacology and Therapeutics 39: 1276-1285. https://doi.org/10.1111/apt.12758
Aller, R., De Luis, D.A., Izaola, O., Conde, R., Gonzalez Sagrado, M., Primo, D., De La Fuente, B. and Gonzalez, J., 2011. Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial. European Review for Medical and Pharmacological Sciences 15: 1090-1095.
'Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial ' () 15 European Review for Medical and Pharmacological Sciences : 1090 -1095.
Angulo, P., Hui, J.M., Marchesini, G., Bugianesi, E., George, J., Farrell, G.C., Enders, F., Saksena, S., Burt, A.D., Bida, J.P., Lindor, K., Sanderson, S.O., Lenzi, M., Adams, L.A., Kench, J., Therneau, T.M. and Day, C.P., 2007. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 45: 846-854. https://doi.org/10.1002/hep.21496
Asemi, Z., Aarabi, M.H., Hajijafari, M., Alizadeh, S.A., Razzaghi, R., Mazoochi, M. and Esmaillzadeh, A., 2017. Effects of synbiotic food consumption on serum minerals, liver enzymes, and blood pressure in patients with type 2 diabetes: a double-blind randomized cross-over controlled clinical trial. International Journal of Preventive Medicine 8: 43. https://doi.org/10.4103/ijpvm.IJPVM_257_16
Asgharian, A., Askari, G., Esmailzade, A., Feizi, A. and Mohammadi, V., 2016. The effect of symbiotic supplementation on liver enzymes, C-reactive protein and ultrasound findings in patients with non-alcoholic fatty liver disease: a clinical trial. International Journal of Preventive Medicine 7: 59. https://doi.org/10.4103/2008-7802.178533
Asgharian, A., Mohammadi, V., Gholi, Z., Esmaillzade, A., Feizi, A. and Askari, G., 2017. The effect of synbiotic supplementation on body composition and lipid profile in patients with NAFLD: a randomized, double blind, placebo-controlled clinical trial study. Iranian Red Crescent Medical Journal 19: e42902. https://doi.org/10.5812/ircmj.42902
Bakhshimoghaddam, F., Shateri, K., Sina, M., Hashemian, M. and Alizadeh, M., 2018. Daily consumption of synbiotic yogurt decreases liver steatosis in patients with nonalcoholic fatty liver disease: a randomized controlled clinical trial. Journal of Nutrition 148: 1276-1284. https://doi.org/10.1093/jn/nxy088
Begg, C.B. and Mazumdar, M., 1994. Operating characteristics of a bank correlation test for publication bias. Biometrics 50: 1088-1101. https://doi.org/10.2307/2533446
Behrouz, V., Jazayeri, S., Aryaeian, N., Zahedi, M.J. and Hosseini, F., 2017. Effects of probiotic and prebiotic supplementation on leptin, adiponectin, and glycemic parameters in non-alcoholic fatty liver disease: a randomized clinical trial. Middle East Journal of Digestive Diseases 9: 150-157. https://doi.org/10.15171/mejdd.2017.66
Chaimani, A., Higgins, J.P., Mavridis, D., Spyridonos, P. and Salanti, G., 2013. Graphical tools for network meta-analysis in STATA. PLoS ONE 8: e76654. https://doi.org/10.1371/journal.pone.0076654
Chang, H.C., Huang, C.N., Yeh, D.M., Wang, S.J., Peng, C.H. and Wang, C.J., 2013. Oat prevents obesity and abdominal fat distribution, and improves liver function in humans. Plant Foods for Human Nutrition 68: 18-23. https://doi.org/10.1007/s11130-013-0336-2
Cohen, J.C., Horton, J.D. and Hobbs, H.H., 2011. Human fatty liver disease: old questions and new insights. Science 332: 1519-1523. https://doi.org/10.1126/science.1204265
Deeks, J.J., 2002. Issues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes. Statistics in Medicine 21: 1575-1600. https://doi.org/10.1002/sim.1188
Ebrahimi-Mameghani, M., Aliashrafi, S., Javadzadeh, Y. and AsghariJafarabadi, M., 2014. The effect of Chlorella vulgaris supplementation on liver enzymes, serum glucose and lipid profile in patients with non-alcoholic fatty liver disease. Health Promotion Perspectives 4: 107-115. https://doi.org/10.5681/hpp.2014.014
Eckard, C., Cole, R., Lockwood, J., Torres, D.M., Williams, C.D., Shaw, J.C. and Harrison, S.A., 2013. Prospective histopathologic evaluation of lifestyle modification in nonalcoholic fatty liver disease: a randomized trial. Therapeutic Advances in Gastroenterology 6: 249-259. https://doi.org/10.1177/1756283X13484078
Ekhlasi, G., Kolahdouz Mohammadi, R., Agah, S., Zarrati, M., Hosseini, A.F., Arabshahi, S.S. and Shidfar, F., 2016. Do symbiotic and vitamin E supplementation have favorite effects in nonalcoholic fatty liver disease? A randomized, double-blind, placebo-controlled trial. Journal of Research in Medical Sciences 21: 106. https://doi.org/10.4103/1735-1995.193178
Ekhlasi, G., Zarrati, M., Agah, S., Hosseini, A.F., Hosseini, S., Shidfar, S., Soltani Aarbshahi, S.S., Razmpoosh, E. and Shidfar, F., 2017. Effects of symbiotic and vitamin E supplementation on blood pressure, nitric oxide and inflammatory factors in non-alcoholic fatty liver disease. Excli Journal 16: 278-290. https://doi.org/10.17179/excli2016-846
Eslam, M. and George, J., 2016. Genetic and epigenetic mechanisms of NASH. Hepatology International 10: 394-406. https://doi.org/10.1007/s12072-015-9689-y
Eslamparast, T., Poustchi, H., Zamani, F., Sharafkhah, M., Malekzadeh, R. and Hekmatdoost, A., 2014. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. American Journal of Clinical Nutrition 99: 535-542. https://doi.org/10.3945/ajcn.113.068890
Farhangi, M.A., Javid, A.Z. and Dehghan, P., 2016. The effect of enriched chicory inulin on liver enzymes, calcium homeostasis and hematological parameters in patients with type 2 diabetes mellitus: a randomized placebo-controlled trial. Primary Care Diabetes 10: 265-271. https://doi.org/10.1016/j.pcd.2015.10.009
Federico, A., Zulli, C., De Sio, I., Del Prete, A., Dallio, M., Masarone, M. and Loguercio, C., 2014. Focus on emerging drugs for the treatment of patients with non-alcoholic fatty liver disease. World Journal of Gastroenterology 20: 16841-16857. https://doi.org/10.3748/wjg.v20.i45.16841
Ferolla, S.M., Couto, C.A., Costa-Silva, L., Armiliato, G.N., Pereira, C.A., Martins, F.S., Ferrari, M.D.L.A., Vilela, E.G., Torres, H.O., Cunha, A.S. and Ferrari, T.C., 2016. Beneficial effect of synbiotic supplementation on hepatic steatosis and anthropometric parameters, but not on gut permeability in a population with nonalcoholic steatohepatitis. Nutrients 8: 397. https://doi.org/10.3390/nu8070397
Finelli, C. and Tarantino, G., 2012. Have guidelines addressing physical activity been established in nonalcoholic fatty liver disease? World Journal of Gastroenterology 18: 6790-6800. https://doi.org/10.3748/wjg.v18.i46.6790
Gibson, G.R., Hutkins, R., Sanders, M.E., Prescott, S.L., Reimer, R.A., Salminen, S.J., Scott, K., Stanton, C., Swanson, K.S., Cani, P.D., Verbeke, K. and Reid, G., 2017. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nature Reviews Gastroenterology and Hepatology 14: 491-502. https://doi.org/10.1038/nrgastro.2017.75
Guyatt, G., Oxman, A.D., Sultan, S., Brozek, J., Glasziou, P., Alonso-Coello, P., Atkins, D., Kunz, R., Montori, V., Jaeschke, R., Rind, D., Dahm, P., Akl, E.A., Meerpohl, J., Vist, G., Berliner, E., Norris, S., Falck-Ytter, Y. and Schunemann, H.J., 2013. GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. Journal of Clinical Epidemiology 66: 151-157. https://doi.org/10.1016/j.jclinepi.2012.01.006
Hadi, A., Mohammadi, H., Miraghajani, M. and Ghaedi, E., 2019. Efficacy of synbiotic supplementation in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis of clinical trials: synbiotic supplementation and NAFLD. Critical Reviews in Food Science and Nutrition 59: 2494-2505. https://doi.org/10.1080/10408398.2018.1458021
Javadi, L., Ghavami, M., Khoshbaten, M., Safaiyan, A., Barzegari, A. and Pourghassem Gargari, B., 2017. The effect of probiotic and/or prebiotic on liver function tests in patients with nonalcoholic fatty liver disease: a double blind randomized clinical trial. Iranian Red Crescent Medical Journal 19: e46017.
'The effect of probiotic and/or prebiotic on liver function tests in patients with nonalcoholic fatty liver disease: a double blind randomized clinical trial ' () 19 Iranian Red Crescent Medical Journal : e46017.
Khan, M.Y., Mihali, A.B., Rawala, M.S., Aslam, A. and Siddiqui, W.J., 2019. The promising role of probiotic and synbiotic therapy in aminotransferase levels and inflammatory markers in patients with nonalcoholic fatty liver disease – a systematic review and meta-analysis. European Journal of Gastroenterology and Hepatology 31: 703-715. https://doi.org/10.1097/MEG.0000000000001371
Knapp, G. and Hartung, J., 2003. Improved tests for a random effects meta-regression with a single covariate. Statistics in Medicine 22: 2693-2710. https://doi.org/10.1002/sim.1482
Lee, J., Kim, Y., Friso, S. and Choi, S.W., 2017. Epigenetics in non-alcoholic fatty liver disease. Molecular Aspects of Medicine 54: 78-88. https://doi.org/10.1016/j.mam.2016.11.008
Li, J., Zou, B., Yeo, Y.H., Feng, Y., Xie, X., Lee, D.H., Fujii, H., Wu, Y., Kam, L.Y., Ji, F., Li, X., Chien, N., Wei, M., Ogawa, E., Zhao, C., Wu, X., Stave, C.D., Henry, L., Barnett, S., Takahashi, H., Furusyo, N., Eguchi, Y., Hsu, Y.-C., Lee, T.-Y., Ren, W., Qin, C., Jun, D.W., Toyoda, H., Wong, V.W.-S., Cheung, R., Zhu, Q. and Nguyen, M.H., 2019. Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis. The Lancet Gastroenterology and Hepatology 4: 389-398. https://doi.org/10.1016/s2468-1253(19)30039-1
Liu, L., Li, P., Liu, Y. and Zhang, Y., 2019. Efficacy of probiotics and synbiotics in patients with nonalcoholic fatty liver disease: a meta-analysis. Digestive Diseases and Sciences 64: 3402-3412. https://doi.org/10.1007/s10620-019-05699-z
Loman, B.R., Hernandez-Saavedra, D., An, R. and Rector, R.S., 2018a. Prebiotic and probiotic treatment of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Nutrition Reviews 76: 822-839. https://doi.org/10.1093/nutrit/nuy031
Loman, B.R., Hernandez-Saavedra, D., An, R. and Rector, R.S., 2018b. Prebiotic and probiotic treatment of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Nutrition Reviews 76: 822-839. https://doi.org/10.1093/nutrit/nuy031
Ma, J., Zhou, Q. and Li, H., 2017. Gut microbiota and nonalcoholic fatty liver disease: insights on mechanisms and therapy. Nutrients 9: 1124. https://doi.org/10.3390/nu9101124
Ma, Y.Y., Li, L., Yu, C.H., Shen, Z., Chen, L.H. and Li, Y.M., 2013. Effects of probiotics on nonalcoholic fatty liver disease: a meta-analysis. World Journal of Gastroenterology 19: 6911-6918. https://doi.org/10.3748/wjg.v19.i40.6911
Malaguarnera, M., Vacante, M., Antic, T., Giordano, M., Chisari, G., Acquaviva, R., Mastrojeni, S., Malaguarnera, G., Mistretta, A., Li Volti, G. and Galvano, F., 2012. Bifidobacterium longum with fructo-oligosaccharides in patients with non alcoholic steatohepatitis. Digestive Diseases and Sciences 57: 545-553. https://doi.org/10.1007/s10620-011-1887-4
Miccheli, A., Capuani, G., Marini, F., Tomassini, A., Pratico, G., Ceccarelli, S., Gnani, D., Baviera, G., Alisi, A., Putignani, L. and Nobili, V., 2015. Urinary (1)H-NMR-based metabolic profiling of children with NAFLD undergoing VSL#3 treatment. International Journal of Obesity 39: 1118-1125. https://doi.org/10.1038/ijo.2015.40
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. and the PRISMA Group, 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology 62: 1006-1012. https://doi.org/10.1016/j.jclinepi.2009.06.005
Nabavi, S., Rafraf, M., Somi, M.H., Homayouni-Rad, A. and Asghari-Jafarabadi, M., 2014. Effects of probiotic yogurt consumption on metabolic factors in individuals with nonalcoholic fatty liver disease. Journal of Dairy Science 97: 7386-7393. https://doi.org/10.3168/jds.2014-8500
Neuschwander-Tetri, B.A. and Caldwell, S.H., 2003. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference Hepatology 38: 1202-1219. https://doi.org/10.1053/jhep.2003.50193
Propadalo, I., Tranfic, M., Vuka, I., Barcot, O., Pericic, T.P. and Puljak, L., 2019. In Cochrane reviews, risk of bias assessments for allocation concealment were frequently not in line with Cochrane’s Handbook guidance. Journal of Clinical Epidemiology 106: 10-17. https://doi.org/10.1016/j.jclinepi.2018.10.002
Rondanelli, M., Faliva, M.A., Perna, S., Giacosa, A., Peroni, G. and Castellazzi, A.M., 2017. Using probiotics in clinical practice: where are we now? A review of existing meta-analyses. Gut Microbes 8: 521-543. https://doi.org/10.1080/19490976.2017.1345414
Rucker, G., Schwarzer, G., Carpenter, J.R. and Schumacher, M., 2008. Undue reliance on I(2) in assessing heterogeneity may mislead. BMC Medical Research Methodology 8: 79. https://doi.org/10.1186/1471-2288-8-79
Said, A., 2013. Non-alcoholic fatty liver disease and liver transplantation: outcomes and advances. World Journal of Gastroenterology 19: 9146-9155. https://doi.org/10.3748/wjg.v19.i48.9146
Salanti, G., Ades, A.E. and Ioannidis, J.P., 2011. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. Journal of Clinical Epidemiology 64: 163-171. https://doi.org/10.1016/j.jclinepi.2010.03.016
Schneider, A.L., Lazo, M., Selvin, E. and Clark, J.M., 2014. Racial differences in nonalcoholic fatty liver disease in the U.S. population. Obesity 22: 292-299. https://doi.org/10.1002/oby.20426
Sridharan, K., Sivaramakrishnan, G., Sequeira, R.P. and Elamin, A., 2018. Pharmacological interventions for non-alcoholic fatty liver disease: a systematic review and network meta-analysis. Nutrition Reviews 94: 556-565. https://doi.org/10.1136/postgradmedj-2018-135967
Stang, A., 2010. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology 25: 603-605. https://doi.org/10.1007/s10654-010-9491-z
Stowell, J., 2007. Nutritional approaches to gut health: fibre, prebiotics, probiotics and synbiotics – a summary of definitions and implications of recent legislation. Agro Food Industry Hi Tech 18(2): 20-23.
'Nutritional approaches to gut health: fibre, prebiotics, probiotics and synbiotics – a summary of definitions and implications of recent legislation ' () 18 Agro Food Industry Hi Tech : 20 -23.
Tarantino, G. and Finelli, C., 2015. Systematic review on intervention with prebiotics/probiotics in patients with obesity-related nonalcoholic fatty liver disease. Future Microbiology 10: 889-902. https://doi.org/10.2217/fmb.15.13
Vajro, P., Mandato, C., Licenziati, M.R., Franzese, A., Vitale, D.F., Lenta, S., Caropreso, M., Vallone, G. and Meli, R., 2011. Effects of Lactobacillus rhamnosus strain GG in pediatric obesity-related liver disease. Journal of Pediatric Gastroenterology and Nutrition 52: 740-743. https://doi.org/10.1097/MPG.0b013e31821f9b85
Wong, V.W., Tse, C.H., Lam, T.T., Wong, G.L., Chim, A.M., Chu, W.C., Yeung, D.K., Law, P.T., Kwan, H.S., Yu, J., Sung, J.J. and Chan, H.L., 2013. Molecular characterization of the fecal microbiota in patients with nonalcoholic steatohepatitis – a longitudinal study. PLoS ONE 8: e62885. https://doi.org/10.1371/journal.pone.0062885
Zhang, J.Z., Cai, J.J., Yu, Y., She, Z.G. and Li, H., 2019. Nonalcoholic fatty liver disease: an update on the diagnosis. Gene Expression 19: 187-198. https://doi.org/10.3727/105221619X15553433838609
| All Time | Past 365 days | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1226 | 411 | 29 |
| Full Text Views | 22 | 8 | 0 |
| PDF Views & Downloads | 42 | 19 | 0 |
Many studies have associated altered intestinal bacterial communities and non-alcoholic fatty liver disease, but the putative effects are inconclusive. The purpose of this network meta-analysis (NMA) was to evaluate the effects of probiotics, prebiotics, and synbiotics on non-alcoholic fatty liver disease through randomised intervention trials. Literature searches were performed until March 2020. For each outcome, a random NMA was performed, the surface under the cumulative ranking curve (SUCRA) was determined. A total of 22 randomised trials comparing prebiotic, probiotic, and synbiotic treatments included 1301 participants. Considering all seven results (aspartate aminotransferase, alanine aminotransferase, body mass index, weight, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) together, the highest SUCRA values are probiotics (94%), synbiotics (61%) and prebiotics (56%), respectively. NMA results provide evidence that probiotics, prebiotics, and synbiotics can alleviate non-alcoholic fatty liver disease. However, due to the lack of high-quality randomised trials, this research also has some limitations.
| All Time | Past 365 days | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1226 | 411 | 29 |
| Full Text Views | 22 | 8 | 0 |
| PDF Views & Downloads | 42 | 19 | 0 |