Using synbiotics supplementation to treat hepatic steatosis: A comprehensive meta-analysis of randomized controlled trials

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that occurs in a quarter of the global adult population. Thus far, NAFLD treatments are limited to lifestyle change and medicines with considerable adverse effects, with other novel treatment of choice, such as gut microbiota supplementation are currently being researched. This meta-analysis compares the effectiveness of prebiotics, probiotics, synbiotics, and placebo treatments for NAFLD-hepatic steatosis and has been written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Assessment of the bias risk of the included studies used Cochrane Risk of Bias Tool 2. The literature search was conducted by five independent researchers from November 15, 2022, to December 20, 2022. Twenty studies, limited to English language publications, have been included in the qualitative synthesis, with nineteen of those also included in the quantitative synthesis using RevMan 5.4. The outcomes of interest are Liver Stiffness Measurement (LSM), serum Alanine transaminase (ALT), aspartate transaminase (AST), homeostatic model assessment for insulin resistance (HOMA-IR), and intrahepatic triglyceride (IHTG). Out of the five outcomes of interest, AST, ALT, and IHTG demonstrate statistically significant results, supporting the use of synbiotic supplements rather than the placebo treatment, but LSM and HOMA-IR producing statistically insignificant results. Synbiotic supplements may serve as an alternative treatment for hepatic steatosis patients with NAFLD due to its significant benefit in reducing AST, ALT, and IHTG. Further research combined with other treatment plan might be of interest in this treatment method.

This systematic review has been registered to the PROSPERO database (CRD42023392048).