Optimal probiotic combinations for treating nonalcoholic fatty liver disease: A systematic review and network meta-analysis

Yafang Yang; Ligang Yang; Jiale Wu; Jing Hu; Min Wan; Jindi Bie; Jiaxin Li; Da Pan; Guiju Sun; Chao Yang

doi:10.1016/j.clnu.2024.04.004

Optimal probiotic combinations for treating nonalcoholic fatty liver disease: A systematic review and network meta-analysis

Clin Nutr. 2024 Apr 13;43(6):1224-1239. doi: 10.1016/j.clnu.2024.04.004. Online ahead of print.

Authors

Yafang Yang¹, Ligang Yang², Jiale Wu¹, Jing Hu¹, Min Wan¹, Jindi Bie³, Jiaxin Li³, Da Pan², Guiju Sun², Chao Yang⁴

Affiliations

¹ Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi 214000, China.
² Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
³ Department of Clinical Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi 214000, China.
⁴ Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi 214000, China. Electronic address: chaoyang@jiangnan.edu.cn.

PMID: 38643738
DOI: 10.1016/j.clnu.2024.04.004

Abstract

Background: Probiotic administration is a promising therapy for improving conditions in NAFLD patients. This network meta-analysis aimed to compare and estimate the relative effects of probiotic interventions and identify the optimal probiotic species for the treatment of NAFLD (Nonalcoholic fatty liver disease) patients.

Methods: The PubMed, Web of Science, Embase, and Cochrane databases were searched from inception to 29 January 2024 to identify RCTs that were published in English. The GRADE framework was used to assess the quality of evidence contributing to each network estimate.

Results: A total of 35 RCTs involving 2212 NAFLD patients were included in the analysis. For primary outcomes, Lactobacillus + Bifidobacterium + Streptococcus exhibited the highest probability of being the finest probiotic combination in terms of enhancing acceptability as well as reducing AST (SMD: -1.95 95% CI: -2.90, -0.99), ALT (SMD = -1.67, 95% CI: -2.48, -0.85), and GGT levels (SMD = -2.17, 95% CI: -3.27, -1.06). In terms of the secondary outcomes, Lactobacillus + Bifidobacterium + Streptococcus was also the best probiotic combination for reducing BMI (SMD = -0.45, 95% CI: -0.86, -0.04), LDL levels (SMD = -0.45, 95% CI: -0.87, -0.02), TC levels (SMD = -1.09, 95% CI: -1.89, -0.29), and TNF-α levels (SMD = -1.73, 95% CI: -2.72, -0.74).

Conclusion: This network meta-analysis revealed that Lactobacillus + Bifidobacterium + Streptococcus may be the most effective probiotic combination for the treatment of liver enzymes, lipid profiles, and inflammation factors. These findings can be used to guide the development of a probiotics-based treatment guideline for NAFLD since there are few direct comparisons between different therapies.

Keywords: Acceptability; Efficacy; Lipid profiles; Liver enzymes; Probiotics.