Nonalcoholic Fatty Liver Disease: Modulating Gut Microbiota to Improve Severity?

Abstract

Gut microbiota plays a role in the pathophysiology of metabolic diseases which also include nonalcoholic fatty liver diseases (NAFLD), through the gut-liver axis. To date, clinical guidelines recommend a weight loss goal of 7 to 10% to improve features of NAFLD.Nevertheless, since this target is not easily achieved by all patients, alternative therapeutic options are currently being evaluated. This review focusses on therapeutics that aims to modulate the gut microbiota and the gut-liver axis. We will herein discuss how probiotics, prebiotics, synbiotic, fecal microbiota transfer, polyphenols, specific diets and exercise interventions have been shown to modify gut microbiota signatures, improve NAFLD outcomes and detail, when available, the different mechanisms by which these beneficial outcomes might occur. Apart from probiotics which have already been tested in human RCTs, most of these potential therapeutics have been studied in animals. Their efficacy still warrants confirmation in humans using appropriate design.

Multiple Parallel Hits Hypothesis in Nonalcoholic Fatty Liver Disease: Revisited After a Decade

“…( 53 ) Due to space constraints, we do not discuss the important role of an impaired intestinal barrier in the pathogenesis of obesity‐related disorders and NAFLD. ( 54 ) Vice versa, numerous experimental and clinical studies are targeting the intestinal microbiota to modulate susceptibility to NAFLD, as excellently reviewed recently ( 55 ) (see Fig. 1).…”

Nonalcoholic fatty liver disease or metabolic dysfunction‐associated fatty liver disease diagnoses and cardiovascular diseases: From epidemiology to drug approaches

“…Obesity and nutrition may alter intestinal permeability producing a favourable micro‐environment for bacterial overgrowth, mucosal inflammation and translocation of both invasive pathogens and harmful by‐products which influence liver fat composition and exacerbate pro‐inflammatory and fibrotic processes 195,196 . Combination of probiotics, that is non‐pathogenic microorganisms with health benefits, with prebiotic fibres containing non‐digestible carbohydrates, modulates specific changes in the composition and activity of gastrointestinal microbiota, leading to the production of active synbiotics 197 .…”

Microbiota‐derived extracellular vesicles and metabolic syndrome

“…Targeting the gut microbiota as a new method of disease treatment and management is gaining a lot of attention 117 . Indeed, gut microbiota modulation by diet modification, physical exercise or prebiotics/probiotics supplementation seems to have proven efficacy in improving MetS or NAFLD 118–120 . Additionally, the use of beneficial bacterial EVs seems to be a very promising new approach to disease enhancement 121,122 .…”