Effects of probiotics on nonalcoholic fatty liver disease: a meta-analysis

Abstract

Aim: To investigate the relationship between the gut-liver axis and nonalcoholic fatty liver disease (NAFLD), we performed a meta-analysis to evaluate the effects of probiotic therapy in NAFLD.

Methods: We searched PubMed, Medline, Embase, Web of Science, the Cochrane Library and Chinese Biomedicine Database for all relevant randomized controlled trials on probiotics in patients with NAFLD/nonalcoholic steatohepatitis (NASH). A statistical analysis was performed using RevMan 5.0 software.

Results: Four randomized trials involving 134 NAFLD/NASH patients were included. The results showed that probiotic therapy significantly decreased alanine aminotransferase (ALT), aspartate transaminase (AST), total-cholesterol (T-chol), high density lipoprotein (HDL), tumor necrosis factor (TNF)-α and homeostasis model assessment of insulin resistance (HOMA-IR) [ALT: weighted mean difference (WMD) -23.71, 95%CI: -33.46--13.95, P < 0.00001; AST: WMD -19.77, 95%CI: -32.55--7.00, P = 0.002; T-chol: WMD -0.28, 95%CI: -0.55--0.01, P = 0.04; HDL: WMD -0.09, 95%CI: -0.16-0.01, P = 0.03; TNF-α: WMD -0.32, 95%CI: -0.48--0.17, P < 0.0001; HOMA-IR: WMD -0.46, 95%CI: -0.73--0.19, P = 0.0008]. However, the use of probiotics was not associated with changes in body mass index (BMI), glucose (GLU) and low density lipoprotein (LDL) (BMI: WMD 0.05, 95%CI: -0.18-0.29, P = 0.64; GLU: WMD 0.05, 95%CI: -0.25-0.35, P = 0.76; LDL: WMD -0.38, 95%CI: -0.78-0.02, P = 0.06).

Conclusion: Probiotic therapies can reduce liver aminotransferases, total-cholesterol, TNF-α and improve insulin resistance in NAFLD patients. Modulation of the gut microbiota represents a new treatment for NAFLD.

Keywords: Insulin resistance; Liver function; Meta-analysis; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Probiotics.

Figures

Figure 1

Selection of studies.

Figure 2

Forest plot of the effects of probiotics in patients with nonalcoholic fatty liver disease. A: BMI; B: The level of serum ALT; C: The level of serum AST; D:The level of serum T-chol; E: The level of serum LDL; F: The level of serum HDL; G: The level of serum GLU; H: The level of serum TNF-α; I: HOMA. BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate transaminase; T-chol: total-cholesterol; LDL: Low density lipoprotein; HDL: High density lipoprotein; GLU: Glucose; HOMA: Homeostasis model assessment.