Year: 2024 | Month: December | Volume: 11 | Issue: 12 | Pages: 194-200
DOI: https://doi.org/10.52403/ijrr.20241223
The Impact of Probiotic, Prebiotic, and Synbiotic Supplementation on Reducing Inflammation in NAFLD Patients: A Systematic Review
Zulqadri Ginting1, Religus Pinem2
1,2Department of Internal Medicine, Imelda Pekerja Indonesia Hospital, Medan, Indonesia
Corresponding Author: Zulqadri Ginting
ABSTRACT
Background: Non-alcoholic fatty liver disease (NAFLD) is part of the metabolic syndrome and includes a range of liver conditions, from simple fat accumulation (steatosis) to liver inflammation (steatohepatitis), and eventually, liver cirrhosis. An imbalance in gut bacteria (gut dysbiosis) is a key factor in the development and progression of NAFLD. This imbalance leads to pro-inflammatory activity and immune system disruption, which contribute to chronic inflammation and are linked to the formation of liver fibrosis.
Objective/aim: To assess the impact of probiotic, prebiotic, and synbiotic supplementation on decreasing inflammation in individuals with NAFLD.
Method: A systematic literature search was performed on PubMed, EBSCO, and Cochrane to identify randomized controlled trial (RCT) articles published between 2011 and 2021. The search terms used on PubMed included (NAFLD [MeSH Terms]) AND (((Probiotic [MeSH Terms]) OR (Prebiotic [MeSH Terms])) OR (Synbiotic [MeSH Terms])); on EBSCO, the terms were (NAFLD or non-alcoholic fatty liver disease) AND (probiotic OR prebiotic OR synbiotic); and on Cochrane, the search terms were (NAFLD AND Probiotic OR Prebiotic OR Synbiotic). The inclusion criteria were studies involving NAFLD patients aged 18 and older who received probiotic, prebiotic, or synbiotic treatment for at least 8 weeks, or a placebo as an add-on to standard NAFLD treatment. Studies were excluded if they lacked inflammatory biomarker outcomes (hs-CRP, IL-6, TNF-a), involved control subjects receiving non-standard therapy, or did not provide a full-text article.
Results: The literature search identified 192 studies, of which 11 randomized controlled trials (RCTs) were included in our analysis. Most of these studies demonstrated a significant reduction in TNF-a levels in the intervention group. Three studies reported a significant decrease in hs-CRP and IL-6 levels in the intervention group, though some studies found these reductions to be insignificant. One study showed a significant reduction in IL-1b, while NF-kB 65 levels were significantly reduced in two studies. Most studies indicated a significant improvement in NAS and CAP scores, with greater improvements observed in the intervention group compared to the placebo group.
Conclusion: Probiotic, prebiotic, or synbiotic supplements can be used as an additional therapy for NAFLD patients to reduce inflammation, potentially slowing the progression of liver disease.
Keywords: probiotic, prebiotic, symbiotic, NAFLD, inflammation
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