A Specifically Tailored Multistrain Probiotic and Micronutrient Mixture Affects Nonalcoholic Fatty Liver Disease—Related Markers in Patients with Obesity after Mini Gastric Bypass Surgery

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is frequent among patients undergoing bariatric surgery. Beyond weight reduction, dietary supplements like micronutrients or probiotics that modify insulin resistance and lipotoxicity can be used to prevent or delay the progression of liver disease. Objectives We evaluated the effect of a dietary approach with a specifically tailored multistrain probiotic and micronutrient mixture compared with a basic care micronutrient supplement on serum alanine aminotransferase (ALAT) in obese patients after mini gastric bypass (MGB) surgery. Methods This randomized, double-blind, controlled trial included 60 obese patients (age: 40 ± 10 y; BMI: 44 ± 3 kg/m²). Patients received a combination of specifically tailored multistrain probiotic powder and a specific micronutrient mixture (Pro+SM) or a control treatment consisting of a placebo and a basic care micronutrient mixture (Con+BM), with some micronutrients in lower doses than SM, for 12 wk after hospital discharge. Primary (serum ALAT) and secondary outcomes [serum aspartate aminotransferase (ASAT), fatty liver index, NAFLD fibrosis score, glucose metabolism, blood pressure (BP), heart rate] were assessed at week 0 and week 12. Data were analyzed using unpaired Student's t-tests or Mann-Whitney U tests to compare the changes due to each treatment to one another. Results A total of 48 patients were included in the analyses. Changes in serum ALAT concentrations did not differ between groups. Compared with Con+BM, Pro+SM improved serum ASAT (difference: –8.0 U/L, 95% CI: –17.0, –4.0; P = 0.043), NAFLD fibrosis score (difference: –0.39; 95% CI: –0.78, 0; P = 0.048), serum triglycerides (difference: –22.8 mg/dL; 95% CI: –45.6, –0.1; P = 0.049) and the visceral adiposity index (difference: –0.70; 95% CI: –1.31, –0.08; P = 0.027). Conclusion Supplementation with a specifically tailored probiotic and micronutrient mixture improved NAFLD-related markers more than a basic micronutrient mixture in obese patients following MGB surgery. The trial was registered under clinicaltrials.gov as NCT03585413.

The effects of supplementation of probiotics, prebiotics, or synbiotics on patients with non-alcoholic fatty liver disease: A meta-analysis of randomized controlled trials

“…These studies included 741 individuals (392 patients with NAFLD, and 349 healthy individuals). The included studies were published from Jan 2020 to Jul 2022, and conducted in Asia ( 9 , 28 ), North America ( 11 ), and Europe ( 8 , 10 , 12 , 15 , 16 , 18 , 29 , 30 ), respectively. There are eight studies with the probiotics intervention, two with synbiotics intervention, and one with prebiotics intervention for patients with NAFLD.…”

“…Although multiple treatments have been used to improve or prevent NAFLD disease, a healthy lifestyle is always the most common and effective intervention for NAFLD. For example, a body mass loss of 3–5% could decrease cardiovascular risk, a body mass loss of 2–5% lower the level of HbA1c in T2DM patients, and a body mass loss of 7–10% could improve insulin sensitivity, liver enzyme concentrations, and liver steatosis and fibrosis in obese NAFLD patients ( 10 , 31 ). Researchers investigated the BMI, and dietary habits (energy, carbohydrate, and fat intake) of NAFLD patients in the included trials.…”

“…Several researchers have investigated the effectiveness of microbial therapies for NAFLD (8)(9)(10)(11)(12). Probiotics, for instance, have been confirmed as a group of active microorganisms that are beneficial to the host by colonizing the human gut and reproductive system to improve the host's imbalanced microbiota (13).…”

Gut microbiota–mitochondrial inter-talk in non-alcoholic fatty liver disease

“…levels of ALT, AST, TC, HDL, and TNF-α and improve IR in patients with NASH (86). In addition, a randomized controlled study revealed that patients with NAFLD treated daily with Lactobacillus and Bifidobacterium species showed decreased levels of ALT and γGT, decreased counts of CD4+ T-cells and CD8+ T-cells, and improved HS fibrosis (87).…”

“…Previous investigations have suggested that probiotics enhance the barrier function of epithelial cells and decrease intestinal permeability and endotoxemia in patients with liver disease. Probiotic therapy can significantly decrease the levels of ALT, AST, TC, HDL, and TNF-α and improve IR in patients with NASH ( 86 ). In addition, a randomized controlled study revealed that patients with NAFLD treated daily with Lactobacillus and Bifidobacterium species showed decreased levels of ALT and γGT, decreased counts of CD4+ T-cells and CD8+ T-cells, and improved HS fibrosis ( 87 ).…”