Probiotics for patients with compensated liver cirrhosis: a double-blind placebo-controlled study. Effect of pre- and probiotics on liver regeneration after resection: a randomised, double-blind pilot study. Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a pilot study. Supply of Pre‐ and Probiotics Reduces Bacterial Infection Rates After Liver Transplantation—A Randomized, Double‐Blind Trial A Multi-strain Probiotic Reduces the Fatty Liver Index, Cytokines and Aminotransferase levels in NAFLD Patients: Evidence from a Randomized Clinical Trial. Short-term probiotic therapy alleviates small intestinal bacterial overgrowth, but does not improve intestinal permeability in chronic liver disease Probiotic Yogurt Effects on Intestinal Flora of Patients with Chronic Liver Disease Effects of probiotics (cultured Lactobacillus subtilis/Streptococcus faecium) in the treatment of alcoholic hepatitis: randomized-controlled multicenter study Beneficial effects of probiotic combination with omega-3 fatty acids in NAFLD: a randomized clinical study. Supplementation with probiotics modifies gut flora and attenuates liver fat accumulation in rat nonalcoholic fatty liver disease model Effect of probiotic treatment on deranged neutrophil function and cytokine responses in patients with compensated alcoholic cirrhosis. Supplementation of Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032 in Diet-Induced Obese Mice Is Associated with Gut Microbial Changes and Reduction in Obesity Effect of microbial cell preparation on renal profile and liver function among type 2 diabetics: a randomized controlled trial Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Histological improvement of non-alcoholic steatohepatitis with a prebiotic: a pilot clinical trial Fighting Fatty Liver Diseases with Nutritional Interventions, Probiotics, Symbiotics, and Fecal Microbiota Transplantation (FMT).
BACKGROUND Gut flora is related to the major complications of liver cirrhosis including hepatic encephalopathy , spontaneous bacterial peritonitis , and variceal bleeding . Prior studies have reported a beneficial effect of gut flora modification with probiotic bacteria in patients with minimal hepatic encephalopathy . We aim ed to study the effect of probiotics on clinical and laboratory parameters of patients with compensated cirrhosis . METHODS A double-blind placebo-controlled study that included patients with liver cirrhosis and at least one major complication of cirrhosis in the past , clinical evidence of portal hypertension , or decreased hepatic synthetic function . Participants were r and omly assigned to receive probiotic capsules containing Lactobacillus acidophilus , Lactobacillus bulgaricus , Bifidobacterium lactis , and Streptococcus thermophiles or placebo for a period of 6 mo . RESULTS A total of 36 patients were available for final analysis ( distributed equally between the probiotic and placebo groups ) . The administration of probiotics was not associated with significant differences in either clinical or laboratory parameters between the two groups . Because the lack of a beneficial effect may be related to the compensated liver disease of patients , we conducted a sub analysis of patients with baseline ammonia levels > 50 mmol/L. In this subgroup , the administration of probiotics appeared to significantly reduce the ammonia levels starting after 1 mo of treatment . However , this effect diminished and lost its significance following comparison to the placebo group . CONCLUSIONS Our study did not show a significant beneficial effect of probiotic supplementation in patients with compensated liver cirrhosis . Nevertheless , it points toward a possible positive effect of probiotics in patients with above normal baseline ammonia levels . This issue requires further investigation in larger cohorts Liver regeneration is a prerequisite for extended liver surgery . Several studies have shown that the bacterial gut flora is able to modulate liver function . Previously we observed that synbiotics could partly reverse the impaired mitosis rate of hepatocytes in a rat model of synchronous liver resection and colon anastomosis . The effect of synbiotics on liver function after hepatic resection has not been analysed yet . A prospect i ve r and omised double-blind pilot trial was undertaken in 19 patients scheduled for right hepatectomy . All patients received enteral nutrition immediately post-operatively . Comparison was made between a group receiving a combination of four probiotics and four fibres and a placebo group receiving the fibres only starting the day before surgery and continuing for 10 days . Primary study endpoint was the liver function capacity measured by 13C-methacetin breath test and indocyanine green plasma disappearance rate . Portal vein flow , liver volumetry , laboratory parameters for liver function , length of hospital stay , post-operative complications and side effects of synbiotic therapy  were recorded . Liver function capacity was comparable in both groups . Complications had a negative impact on liver function . Because complications were more severe in the verum group , a sub- analysis was performed . In case of an uncomplicated course , liver function capacity was better in the patients with synbiotics . No severe side effects occurred . Synbiotics might be able to increase liver function capacity in patients after liver resection , but patient numbers were too small and the clinical courses too heterogeneous to draw any definite conclusions The effects of chronic alcohol consumption on the bowel flora and the potential therapeutic role of probiotics in alcohol-induced liver injury have not previously been evaluated . In this study , 66 adult Russian males admitted to a psychiatric hospital with a diagnosis of alcoholic psychosis were enrolled in a prospect i ve , r and omized , clinical trial to study the effects of alcohol and probiotics on the bowel flora and alcohol-induced liver injury . Patients were r and omized to receive 5 days of Bifidobacterium bifidum and Lactobacillus plantarum 8PA3 versus st and ard therapy alone ( abstinence plus vitamins ) . Stool cultures and liver enzymes were performed at baseline and again after therapy . Results were compared between groups and with 24 healthy , matched controls who did not consume alcohol . Compared to healthy controls , alcoholic patients had significantly reduced numbers of bifidobacteria ( 6.3 vs. 7.5 log colony-forming unit [CFU]/g ) , lactobacilli ( 3.15 vs. 4.59 log CFU/g ) , and enterococci ( 4.43 vs. 5.5 log CFU/g ) . The mean baseline alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , and gamma-glutamyl transpeptidase ( GGT ) activities were significantly elevated in the alcoholic group compared to the healthy control group ( AST : 104.1 vs. 29.15 U/L ; ALT : 50.49 vs. 22.96 U/L ; GGT 161.5 vs. 51.88 U/L ) , indicating that these patients did have mild alcohol-induced liver injury . After 5 days of probiotic therapy , alcoholic patients had significantly increased numbers of both bifidobacteria ( 7.9 vs. 6.81 log CFU/g ) and lactobacilli ( 4.2 vs. 3.2 log CFU/g ) compared to the st and ard therapy arm . Despite similar values at study initiation , patients treated with probiotics had significantly lower AST and ALT activity at the end of treatment than those treated with st and ard therapy alone ( AST : 54.67 vs. 76.43 U/L ; ALT 36.69 vs. 51.26 U/L ) . In a subgroup of 26 subjects with well-characterized mild alcoholic hepatitis ( defined as AST and ALT greater than 30 U/L with AST-to-ALT ratio greater than one ) , probiotic therapy was associated with a significant end of treatment reduction in ALT , AST , GGT , lactate dehydrogenase , and total bilirubin . In this subgroup , there was a significant end of treatment mean ALT reduction in the probiotic arm versus the st and ard therapy arm . In conclusion , patients with alcohol-induced liver injury have altered bowel flora compared to healthy controls . Short-term oral supplementation with B. bifidum and L. plantarum 8PA3 was associated with restoration of the bowel flora and greater improvement in alcohol-induced liver injury than st and ard therapy alone Bacterial infections frequently occur early after liver transplantation . We recently reported significant progress with a synbiotic composition , consisting of one lactic acid bacteria ( LAB ) and one fiber , which reduced the infection rate from 48 % ( with selective bowel decontamination ) to 13 % . Now , our aim is to study if a combination of different LAB and fibers would further improve outcome BACKGROUND Probiotics have a beneficial effect on nonalcoholic fatty liver disease ( NAFLD ) in animal models . R and omized placebo-controlled trials ( RCTs ) in NAFLD are still lacking in humans despite a large number of data from animal research . AIM We performed a double-blind single center RCT of live multi-strain probiotic vs. placebo in type 2 diabetes patients with NAFLD . METHODS A total of 58 patients met the criteria for inclusion . They were r and omly assigned to receive the multi-probiotic " Symbiter " ( concentrated biomass of 14 probiotic bacteria genera Bifidobacterium , Lactobacillus , Lactococcus , Propionibacterium ) or placebo for 8-weeks administered as a sachet formulation in double-blind treatment . The primary main outcomes were the changes in fatty liver index ( FLI ) and liver stiffness ( LS ) measured by Shear Wave Elastography ( SWE ) . Secondary outcomes were the changes in aminotransferase activity , serum lipids and cytokines ( TNF-α , IL-1β , IL-6 , IL-8 , and IFN-γ ) levels . Analysis of covariance was used to assess the difference between groups . RESULTS In the probiotic group , FLI significantly decreased from 84.33+/-2.23 to 78.73+/-2.58 ( p<0.001 ) but it did not change in the placebo group ( 82.57+/-2.45 to 81.6 + /-2.36 ; p=0.367 ) . In both groups a slight but not significant reduction of LS measured by SWE was detected . Analysis of the secondary outcomes showed that probiotics reduced the level of serum AST and GGT . Among the markers of chronic systemic inflammatory state , only TNF-α and IL-6 levels changed significantly after the treatment with the probiotic . CONCLUSION The probiotic " Symbiter "  reduces liver fat , aminotransferase activity , and the TNF-α and IL-6 levels in NAFLD patients . Modulation of the gut microbiota might represent a new therapy for NAFLD , which should be tested in larger studies Aim : Although numerous animal studies suggest that probiotic therapy has beneficial effects in various liver diseases , the evidence for beneficial effects in human liver disease is controversial . This study was carried out to investigate the efficacy of probiotic therapy in alleviating small intestinal bacterial overgrowth ( SIBO ) and permeability in chronic liver disease . Methods : Fifty-three patients with chronic liver disease were r and omized to either probiotic therapy or placebo . Six bacterial species were used : Bifidobacterium bifidum , Bifidobacterium lactis , Bifidobacterium longum , Lactobacillus acidophilus , Lactobacillus rhamnosus , and Streptococcus thermophilus . After 4 weeks , changes in the composition of fecal bacteria , SIBO , intestinal permeability , and clinical symptoms were examined . Results : Three of the six probiotic species , B. lactis , L. rhamnosus , and L. acidophilus , increased in the feces of the probiotic therapy group ( P<0.001 ) , whereas there was no change in fecal microbiota in the placebo group . SIBO disappeared in many individuals of the probiotic therapy group , but none in the placebo ( 24 vs. 0 % , P<0.05 ) . General gastrointestinal symptoms also improved more in the probiotic group and improvement in intestinal permeability was slightly but not significantly more frequent in the probiotic arm than the placebo arm ( 50 vs. 31.3 % , P=0.248 ) . Numbers of lactobacilli in stool were correlated negatively with intestinal permeability ( P for trend<0.05 ) . Liver chemistry did not improve significantly in either group . Conclusions : We conclude that short-term probiotic administration in chronic liver disease is effective in alleviating SIBO and clinical symptoms , but ineffective in improving intestinal permeability and liver function Background : Patients with chronic liver disease generally have intestinal flora imbalance that is related to the development and worsening of the disease . Objective : The purpose of this study was to evaluate the effects of probiotic yogurt on intestinal flora of patients with chronic liver disease . Methods : A r and omized controlled trial , pretest-posttest control group design , was used . Patients were r and omized to an experimental group ( 41 patients ) or a control group ( 40 patients ) . Patients in the experimental group were given probiotic yogurt ( one cup each time , three times per day for 14 days ) containing Bacillus bifidus , Lactobacillus acidophilus , Lactobacillus bulgaricus , and Streptococcus thermophilus within 2 hours after meals .  Levels of fecal flora , symptoms and signs , and laboratory examination indexes were collected . Results : After intervention , the experimental group had a lower Escherichia coli count and reduced intestinal flora imbalance ( p < .05 ) . Comparison of the experimental and control groups after the intervention showed that the former had improved symptoms and signs , including significant improvement in debilitation , food intake , appetite , abdominal distension , and ascitic fluid ( p < .05 ) . Conclusion : Probiotic yogurt reduces the levels of intestinal flora imbalance and has an additional therapeutic effect on patients with chronic liver disease Background Probiotics might reduce gut-derived microbial lipopolysaccharide ( LPS ) by restoring bowel flora in patients with alcoholic hepatitis ( AH ) . We evaluated the therapeutic effects of probiotics in patients with AH . Patients and methods Between September 2010 and April 2012 , 117 patients ( probiotics 60 and placebo 57 ) were prospect ively r and omized to receive the 7 days of cultured Lactobacillus subtilis/Streptococcus faecium ( 1500 mg/day ) or placebo .  All patients were hospitalized and were not permitted to consume alcohol for the 7 days of the study . Liver function test , proinflammatory cytokines , LPS , and colony-forming units by stool culture were examined and compared after therapy . Results In both groups , the mean levels of aspartate aminotransferase/alanine aminotransferase , alkaline phosphatase , & ggr;-glutamyl transpeptidase , bilirubin , and prothrombin time were significantly improved after 7 days of abstinence . In the probiotics group ( baseline and after ) , albumin ( 3.5±0.7 and 3.7±0.6 g/dl , P=0.038 ) and tumor necrosis factor-&agr ; ( 121±244 and 71±123 pg/ml , P=0.047 ) showed differences . In addition , the number of colony-forming units of Escherichia coli was significantly reduced ( 435±287 and 168±210 , P=0.002 ) . In the placebo group , the level of LPS ( 1.7±2.8 and 2.0±2.7 EU/ml ) was significantly increased . In the intergroup comparison , significant differences in the levels of tumor necrosis factor-&agr ; ( P=0.042 ) and LPS ( P=0.028 ) were observed between the groups . Conclusion Immediate abstinence is the most important treatment for patients with AH . In addition , 7 days of oral supplementation with cultured L. subtilis/S. faecium was associated with restoration of bowel flora and improvement of LPS in patients with AH BACKGROUND The manipulation of gut microbiota via administration of probiotics has been proposed as a potential strategy for the treatment of non-alcoholic fatty liver disease ( NAFLD ) . Hence , we performed a double-blind single center r and omized placebo-controlled trial ( RCT ) to evaluate the efficacy of coadministration of probiotics with omega-3 vs. placebo in type-2 diabetic patients with NAFLD . METHODS A total of 48 patients met the criteria for inclusion . They were r and omly assigned to receive " Symbiter Omega " combination of probiotic biomass supplemented with flax and wheat germ oil ( 250 mg of each , concentration of omega-3 fatty acids 1 - 5 % ) or placebo for 8-weeks . The primary main outcomes were the change in fatty liver index ( FLI ) and liver stiffness ( LS ) measured by Shear Wave Elastography ( SWE ) . Secondary outcomes were the changes in transaminases level , serum lipids and cytokines levels . RESULTS In probiotic-omega group , FLI significantly decreased from 83.53±2.60 to 76.26±2.96 ( P<0.001 ) while no significant changes were observed in the placebo group ( 82.86±2.45 to 81.09±2.84 ; P=0.156 ) . Changes of LS in both groups were insignificant . Analysis of secondary outcomes showed that the coadministration of probiotics with omega-3 lead to significant reduction of serum gamma-glutamyl transpeptidase , triglycerides , and total cholesterol . Chronic systemic inflammatory markers after intervention decrease significantly only in Symbiter Omega group : IL-1β ( P=0.029 ) , TNF-α ( P<0.001 ) , IL-8 ( P=0.029 ) , IL-6 ( P=0.003 ) , and INF-γ ( P=0.016 ) . CONCLUSIONS Coadministration of a live multi-strain probiotic mixture with omega-3 fatty acids once daily for 8 weeks to patients with NAFLD can reduce liver fat , improve serum lipids , metabolic profile , and reduce chronic systemic inflammatory state This study aim ed to evaluate the relationship between gut probiotic flora and nonalcoholic fatty liver disease in a diet-induced rat model , and to compare the effects of two different probiotic strains on nonalcoholic fatty liver disease . Forty male Sprague-Dawley rats were r and omized into 4 groups for 12 weeks : control ( st and ard rat chow ) , model ( fat-rich diet ) , Lactobacillus ( fat-rich diet plus Lactobacillus acidophilus ) , and Bifidobacterium ( fat-rich diet plus Bifidobacterium longum ) groups . Probiotics were provided to rats in drinking water ( 1010/ml ) . Gut bifidobacteria and lactobacilli were obviously lower at weeks 8 and 10 , respectively , in the model group compared with the control group . Supplementation with Bifidobacterium significantly attenuated hepatic fat accumulation ( 0.10 ± 0.03 g/g liver tissue ) compared with the model group ( 0.16 ± 0.03 g/g liver tissue ) . However , there was no improvement in intestinal permeability in either the Lactobacillus or the Bifidobacterium group compared with the model group . In all 40 rats  , the hepatic total lipid content was negatively correlated with gut Lactobacillus ( r = −0.623 , p = 0.004 ) and Bifidobacterium ( r = −0.591 , p = 0.008 ) . Oral supplementation with probiotics attenuates hepatic fat accumulation . Further , Bifidobacterium longum is superior in terms of attenuating liver fat accumulation than is Lactobacillus acidophilus BACKGROUND / AIM Endotoxaemia contributes to neutrophil dysfunction , infection risk and mortality in patients with alcoholic cirrhosis . As probiotics may decrease Gram-negative gut organisms , we hypothesised that probiotic treatment would restore neutrophil function . METHODS In an open-label study , patients with alcoholic cirrhosis ( n=12 ) received Lactobacillus casei Shirota ( 6.5 x 10(9 ) ) 3 times daily for 4 weeks . Data were compared to healthy controls ( n=13 ) and cirrhotic patients ( n=8 ) who did not receive probiotics .  Neutrophil oxidative burst , phagocytosis , toll-like-receptor ( TLR ) expression , plasma cytokines and ex vivo endotoxin-stimulated cytokine production were measured . RESULTS Baseline neutrophil phagocytic capacity in patients was significantly lower compared to healthy controls ( 73 % versus 98 % , p<0.05 ) , but normalised at the end of the study ( n=10 , 100 % , p<0.05 ) . No improvement was seen in disease controls . Soluble TNF-receptor (sTNFR)-1 and -2 and interleukin (IL)10 were significantly elevated in patients ' plasma but did not change during the study . Ex vivo endotoxin-stimulated levels of sTNFR1 , sTNFR2 and IL10 were significantly lower at the end of the study ( p<0.05 ) . TLR2 , 4 and 9 were overexpressed in patients . TLR4 expression normalised by the end of the study . CONCLUSIONS Our data provide a proof-of-concept that probiotics restore neutrophil phagocytic capacity in cirrhosis , possibly by changing IL10 secretion and TLR4 expression , warranting larger r and omised controlled and mechanistic studies Objective To investigate the functional effects of probiotic treatment on the gut microbiota , as well as liver and adipose gene expression in diet-induced obese mice . Design Male C57BL/6J mice were fed a high-fat diet ( HFD ) for 8 weeks to induce obesity , and then r and omized to receive HFD+probiotic ( Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032 , n = 9 ) or HFD+placebo ( n = 9 ) for another 10 weeks . Normal diet ( ND ) fed mice ( n = 9 ) served as non-obese controls . Results Diet-induced obese mice treated with probiotics showed reduced body weight gain and fat accumulation as well as lowered plasma insulin , leptin , total-cholesterol and liver toxicity biomarkers . A total of 151,061 pyrosequencing reads for fecal microbiota were analyzed with a mean of 6,564 , 5,274 and 4,464 reads for the ND , HFD+placebo and HFD+probiotic groups , respectively . Gut microbiota species were shared among the experimental groups despite the different diets and treatments . The diversity of the gut microbiota and its composition were significantly altered in the diet-induced obese mice and after probiotic treatment . We observed concurrent transcriptional changes in adipose tissue and the liver . In adipose tissue , pro-inflammatory genes ( TNFα , IL6 , IL1β and MCP1 ) were down-regulated in mice receiving probiotic treatment . In the liver , fatty acid oxidation-related genes ( PGC1α , CPT1 , CPT2 and ACOX1 ) were up-regulated in mice receiving probiotic treatment . Conclusions The gut microbiota of diet-induced obese mice appears to be modulated in mice  receiving probiotic treatment . Probiotic treatment might reduce diet-induced obesity and modulate genes associated with metabolism and inflammation in the liver and adipose tissue Background The beneficial effect of probiotics on renal profile and liver function has been reported among patients with chronic kidney disease and fatty liver respectively . However , its effect on renal profile and liver function among type 2 diabetic individuals has not been fully understood . To investigate the effect of microbial cell preparation on renal profile and liver function tests among type 2 diabetic individuals . Methods A r and omized , double-blind , parallel-group , controlled clinical trial was conducted on a total of 136 type 2 diabetics age 30 - 70 years old in a teaching hospital in Kuala Lumpur , Malaysia . Subjects were r and omly assigned to receive microbial cell preparation ( N = 68 ) or a placebo ( N = 68 ) for 12 weeks . The outcomes measured at baseline , week 6 , and week 12 and included changes in renal profile ( Sodium , Potassium , Urea , Creatinine , Glomerular Filtration Rate ) , and liver function tests ( Albumin , Total Protein , Alkaline Phosphatase , Alanine Aminotransferase , Aspartate Aminotransferase ) . Intention to treat ( ITT ) analysis was performed on all the recruited subjects , while per protocol ( PP ) analysis was conducted on those who completed the trial with good compliance . Result The urea levels significantly declined in the probiotic group . Serum urea levels reduced from 4.26 mmol/L to 4.04 mmol/L in Probiotic Group while it increased in Placebo Group from 4.03 mmol/L to 4.24 mmol/L. These changes were significant between groups in ITT analysis ( p = 0.018 ) . Other parameters did not change significantly between groups . Conclusion 12 weeks supplementation with daily dosage of 6 × 1010 Colony Forming Units of multi-strain microbial cell preparation significantly improved urea levels . Trial registration ( Clinical trials : # NCT01752803 Minimal hepatic encephalopathy ( MHE ) is an important disorder that may seriously impair daily functioning and quality of life in patients with cirrhosis . Treatment with lactulose is of benefit . The possible role of synbiotics ( probiotics and fermentable fiber ) has not been assessed . We screened 97 consecutive cirrhotic patients without overt hepatic encephalopathy for MHE using the number connection test and measurement of brainstem auditory evoked potentials . MHE , defined by abnormality on at least one test modality , was present in 58 ( 60 % ) patients . Fifty-five of these patients with MHE were r and omized to receive a synbiotic preparation ( n = 20 ) , fermentable fiber alone ( n = 20 ) , or placebo ( n = 15 ) for 30 days . Cirrhotic patients with MHE were found to have substantial derangements in the gut microecology , with significant fecal overgrowth of potentially pathogenic Escherichia coli and Staphylococcal species . Synbiotic treatment significantly increased the fecal content of non-urease-producing Lactobacillus species at the expense of these other bacterial species . Such modulation of the gut flora was associated with a significant reduction in blood ammonia levels and reversal of MHE in 50 % of patients . Synbiotic treatment was also associated with a significant reduction in endotoxemia . The Child-Turcotte-Pugh functional class improved in nearly 50 % of cases . Treatment with fermentable fiber alone was also of benefit in a substantial proportion of patients . In conclusion , treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis BACKGROUND Nonalcoholic fatty liver disease ( NAFLD ) is the most common chronic liver disease in the world . Oral administration of synbiotic has been proposed as an effective treatment of NAFLD because of its modulating effect on the gut flora , which can influence the gut-liver axis . OBJECTIVE The objective was to evaluate the effects of supplementation with synbiotic on hepatic fibrosis , liver enzymes , and inflammatory markers in patients with NAFLD . DESIGN In a r and omized , double-blind , placebo-controlled clinical trial conducted as a pilot study , 52 patients with NAFLD were supplemented twice daily for 28 wk with either a synbiotic or a placebo capsule . Both groups were advised to follow an energy-balanced diet and physical activity recommendations . RESULTS At the end of the study , the alanine aminotransferase ( ALT ) concentration decreased in both groups ; this reduction was significantly greater in the synbiotic group . At the end of the study , the following significant differences [ means ( 95 % CIs ) ] were seen between the synbiotic and placebo groups , respectively : ALT [ -25.1 ( -26.2 , -24 ) compared with -7.29 ( -9.5 , -5.1 ) IU/L ; P < 0.001 ] , aspartate aminotransferase [ -31.33 ( -32.1 , -30.5 ) compared with -7.94 ( -11.1 , -4.8 ) IU/L ; P < 0.001 ] , γ-glutamyltransferase [ -15.08 ( -15.5 , -14.7 ) compared with -5.21 ( -6.6 , -3.9 ) IU/L ; P < 0.001 ] , high-sensitivity C-reactive protein [ -2.3 ( -3 , -1.5 ) compared with -1.04 ( -1.5 , -0.6 ) mmol/L ; P < 0.05 ] , tumor necrosis factor-α [ -1.4 ( -1.7 , -1.1 ) compared with -0.59 ( -0.8 , -0.3 ) mmol/L ; P < 0.001 ] , total nuclear factor κ-B p65 [ -0.016 ( -0.022 , -0.011 ) compared with 0.001 ( -0.004 , -0.007 ) mmol/L ; P < 0.001 ] , and fibrosis score as determined by transient elastography [ - 2.98 ( -3.6 , -2.37 ) compared with -0.77 ( -1.32 , -0.22 ) kPa ; P < 0.001 ] . CONCLUSIONS Synbiotic supplementation in addition to lifestyle modification is superior to lifestyle modification alone for the treatment of NAFLD , at least partially through attenuation of inflammatory markers in the body . Whether these effects will be sustained with longer treatment duration s remains to be determined Purpose In obesity and diabetes the liver is highly susceptible to abnormal uptake and storage of fat . In certain individuals hepatic steatosis predisposes to the development of non-alcoholic steatohepatitis ( NASH ) , a disease marked by hepatic inflammation and fibrosis . Although the precise pathophysiology of NASH is unknown , it is believed that the gut microbiota-liver axis influences the development of this disease . With few treatment strategies available for NASH , exploration of gut microbiota-targeted interventions is warranted . We investigated the therapeutic potential of a prebiotic supplement to improve histological parameters of NASH . Methods In a placebo-controlled , r and omized pilot trial , 14 individuals with liver-biopsy-confirmed NASH [ non-alcoholic fatty liver activity score ( NAS ) ≥ 5 ] were r and omized to receive oligofructose ( 8 g/day for 12 weeks followed by 16 g/day for 24 weeks ) or isocaloric placebo for 9 months . The primary outcome measure was the change in liver biopsy NAS score and the secondary outcomes included changes in body weight , body composition , glucose tolerance , inflammatory markers , and gut microbiota . Results Independent of weight loss  , oligofructose improved liver steatosis relative to placebo and improved overall NAS score ( P = 0.016 ) . Bifidobacterium was enhanced by oligofructose , whereas bacteria within Clostridium cluster XI and I were reduced with oligofructose ( P < 0.05 ) . There were no adverse side effects that deterred individuals from consuming oligofructose for treatment of this disease . Conclusions Independent of other lifestyle changes , prebiotic supplementation  reduced histologically-confirmed steatosis in patients with NASH . Larger follow-up studies are warranted . Clinical TrialThis trial was registered at Clinical trials.com as NCT03184376 Pediatric obesity is rising worldwide leading the worrying phenomenon of nonalcoholic fatty liver disease ( NAFLD ) to shift into one of the most frequent causes of chronic liver illness in childhood . Occurrence of NAFLD depends on several factors such as the geographical area and the diagnostic modalities used ; overall it ranges between 3 % and 10 % of pediatric population , increasing up to 70 % in patients with metabolic comorbidities ( Manco M , Bottazzo G , DeVito R et al , J Am Coll Nutr 27:667 - 676 , 2008).Recent findings have related the intestinal microbiota to a plethora of pathological conditions , including type 2 diabetes ( T2D ) , obesity , and nonalcoholic steatohepatitis ( NASH ) . One of the emerging areas of the study is the link between liver diseases and gut microbiome , which has added new information to the underst and ing of the so-called gut-liver axis . In order to address the role of gut microbiome in NAFLD onset and progression , it is necessary to " decipher " operational codes for microbiome investigation within the context of advanced laboratory medicine to capture microbiome features and , hence , to address the function of the intestinal microbiome within the gut microbiota-liver axis . Results of these investigations have allowed the beginning of implementing the usage of probiotics and symbiotics in the medical approach of  obesity and NAFLD in adults and children . Several r and omized clinical trials ( RCTs ) have been already published on  fecal microbiota transplantation  ( FMT ) , T2D , NASH , and inflammatory bowel disease (IBD).This review proposes to describe the current state of knowledge on the ways fatty liver diseases can be addressed with nutritional interventions , probiotics , symbiotics , and FMT
Subgroup analysis suggested the existence of liver disease at baseline , synbiotics supplementation and duration of supplementation ≥ 8 weeks result ed in more pronounced improvement in liver function enzymes than their counterparts .
Conclusions Probiotics and synbiotics may be suggested as supplements to improve serum concentration of liver enzymes , especially when synbiotics administered for a period ≥ 8 weeks and in individuals with liver disease
Purpose The gut – liver interaction suggests that modification of gut bacterial flora using probiotics and synbiotics may improve liver function .
This systematic review and meta- analysis aim ed to clarify the effect of probiotics and synbiotics consumption on the serum concentration of liver function enzymes .