The Effects of Probiotics, Prebiotics and Synbiotics in Non-Alcoholic Fat Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): A Systematic Review

Abstract

Modifications in the microbiota caused by environmental and genetic reasons can unbalance the intestinal homeostasis, deregulating the host’s metabolism and immune system, intensifying the risk factors for the development and aggravation of non-alcoholic fat liver disease (NAFLD). The use of probiotics, prebiotics and synbiotics have been considered a potential and promising strategy to regulate the gut microbiota and produce beneficial effects in patients with liver conditions. For this reason, this review aimed to evaluate the effectiveness of probiotics, prebiotics, and symbiotics in patients with NAFLD and NASH. Pubmed, Embase, and Cochrane databases were consulted, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed. The clinical trials used in this study demonstrated that gut microbiota interventions could improve a wide range of markers of inflammation, glycemia, insulin resistance, dyslipidemia, obesity, liver injury (decrease of hepatic enzymes and steatosis and fibrosis). Although microbiota modulators do not play a healing role, they can work as an important adjunct therapy in pathological processes involving NAFLD and its spectrums, either by improving the intestinal barrier or by preventing the formation of toxic metabolites for the liver or by acting on the immune system.

Current, emerging, and potential therapies for non-alcoholic steatohepatitis

“…Prebiotics are organic substances that selectively promote the metabolism and proliferation of beneficial bacteria without being digested and absorbed by the host, thereby improving the health of the host. Prebiotics possess high potential to ameliorate NASH, as do probiotics ( Carpi et al, 2022 ). Fecal microbial transplantation (FMT) refers to the transplantation of functional microflora from the donor’s feces into the patient’s gut in an attempt to improve the original intestinal flora imbalance and rebuild the normal intestinal microecology, achieving the treatment of disease ( Khoruts, 2018 ).…”

Can Nutritional Supplements Benefit Patients With Nonalcoholic Steatohepatitis and Nonalcoholic Fatty Liver Disease?

“…(2022) [28] Systematic review Probiotics Probiotics do not play a healing role and work by preventing the formation of toxic metabolites in the liver…”

From probiotics to postbiotics: Concepts and applications

“…Probiotic formulations can regulate the composition and activity of gut microbiota in animals, promoting various physiological functions, such as nutrient digestion and absorption, maintenance of intestinal barrier function, and regulation of immune responses. In addition to their impact on gut health, probiotics have beneficial effects on various health outcomes, including inflammation, blood glucose and lipid abnormalities, liver damage, and bone health [4,5]. Furthermore, probiotics are associated with regulating brain function and behavior, indicating their role in the functioning of the nervous system [6].…”