The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis

BackgroundThe incidence of NAFLD is increasing. Preclinical evidences indicate that modulation of the gut microbiome could be a promising target in nonalcoholic fatty liver disease.MethodA systematic review and network meta-analysis was conducted to compare the effect of probiotics, synbiotics, preb...

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Main Authors: Yijia Song, Sutong Liu, Lihui Zhang, Wenxia Zhao, Yuanmei Qin, Minghao Liu
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-01-01
Series:Frontiers in Nutrition
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Online Access:https://www.frontiersin.org/articles/10.3389/fnut.2024.1470185/full
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author Yijia Song
Yijia Song
Yijia Song
Sutong Liu
Lihui Zhang
Lihui Zhang
Wenxia Zhao
Yuanmei Qin
Yuanmei Qin
Minghao Liu
author_facet Yijia Song
Yijia Song
Yijia Song
Sutong Liu
Lihui Zhang
Lihui Zhang
Wenxia Zhao
Yuanmei Qin
Yuanmei Qin
Minghao Liu
author_sort Yijia Song
collection DOAJ
description BackgroundThe incidence of NAFLD is increasing. Preclinical evidences indicate that modulation of the gut microbiome could be a promising target in nonalcoholic fatty liver disease.MethodA systematic review and network meta-analysis was conducted to compare the effect of probiotics, synbiotics, prebiotics, fecal microbiota transplant, and antibiotics on the liver-enzyme, metabolic effects and liver-specific in patients with NAFLD. The randomized controlled trails (RCTs), limited to English language were searched from database such as Pubmed, Embase, Web of science and Cochrane Library from inception to November 2024. Review Manager 5.3 was used to to draw a Cochrane bias risk. Inconsistency test and publication-bias were assessed by Stata 14.0. Random effect model was used to assemble direct and indirect evidences. The effects of the intervention were presented as mean differences with 95% confidence interval.ResultsA total of 1921 patients from 37 RCTs were eventually included in our study. 23 RCTs evaluated probiotics, 10 RCTs evaluated synbiotics, 4 RCTs evaluated prebiotics, 3 RCTs evaluated FMT and one RCT evaluated antibiotics. Probiotics and synbiotics were associated with a significantly reduction in alanine aminotransferase [ALT, (MD: −5.09; 95%CI: −9.79, −0.39), (MD: −7.38, 95CI%: −11.94, −2.82)] and liver stiffness measurement by elastograph [LSM, (MD: −0.37;95%CI: −0.49, −0.25), (MD: −1.00;95%CI: −1.59, −0.41)]. In addition to, synbiotics was superior to probiotics in reducing LSM. Synbiotics was associated with a significant reduction of Controlled Attenuation Parameter [CAP, (MD: −39.34; 95%CI: −74.73, −3.95)]. Both probiotics and synbiotics were associated with a significant reduction of aspartate transaminase [AST, (MD: −7.81; 95%CI: −15.49, −0.12), (MD: −13.32; 95%CI: −23, −3.64)]. Probiotics and Allogenic FMT was associated with a significant reduction of Homeostatic Model Assessment for Insulin Resistance [HOMA-IR, (MD: −0.7, 95%CI: −1.26, −0.15), (MD: −1.8, 95%CI: −3.53, − 0.07)]. Probiotics was associated with a significant reduction of body mass index [BMI, MD: −1.84, 95%CI: −3.35, −0.33].ConclusionThe supplement of synbiotics and probiotics maybe a promising way to improve liver-enzyme, LSM, and steatosis in patients with NAFLD. More randomized controlled trials are needed to determine the efficacy of FMT and antibiotics on NAFLD. And the incidence of adverse events of MTTs should be further explored.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, CRD42023450093.
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spelling doaj-art-1fb3ec7fc2b540f1a73bfbe74b4f97392025-01-06T05:13:16ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2025-01-011110.3389/fnut.2024.14701851470185The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysisYijia Song0Yijia Song1Yijia Song2Sutong Liu3Lihui Zhang4Lihui Zhang5Wenxia Zhao6Yuanmei Qin7Yuanmei Qin8Minghao Liu9Department of Spleen, Stomach, Hepatobiliary Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, ChinaThe First Clinical Medical School of Henan University of Chinese Medicine, Zhengzhou, ChinaThe Nursing School of Henan University of Chinese Medicine, Zhengzhou, ChinaDepartment of Spleen, Stomach, Hepatobiliary Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, ChinaDepartment of Spleen, Stomach, Hepatobiliary Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, ChinaThe First Clinical Medical School of Henan University of Chinese Medicine, Zhengzhou, ChinaDepartment of Spleen, Stomach, Hepatobiliary Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, ChinaDepartment of Spleen, Stomach, Hepatobiliary Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, ChinaThe Nursing School of Henan University of Chinese Medicine, Zhengzhou, ChinaDepartment of Spleen, Stomach, Hepatobiliary Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, ChinaBackgroundThe incidence of NAFLD is increasing. Preclinical evidences indicate that modulation of the gut microbiome could be a promising target in nonalcoholic fatty liver disease.MethodA systematic review and network meta-analysis was conducted to compare the effect of probiotics, synbiotics, prebiotics, fecal microbiota transplant, and antibiotics on the liver-enzyme, metabolic effects and liver-specific in patients with NAFLD. The randomized controlled trails (RCTs), limited to English language were searched from database such as Pubmed, Embase, Web of science and Cochrane Library from inception to November 2024. Review Manager 5.3 was used to to draw a Cochrane bias risk. Inconsistency test and publication-bias were assessed by Stata 14.0. Random effect model was used to assemble direct and indirect evidences. The effects of the intervention were presented as mean differences with 95% confidence interval.ResultsA total of 1921 patients from 37 RCTs were eventually included in our study. 23 RCTs evaluated probiotics, 10 RCTs evaluated synbiotics, 4 RCTs evaluated prebiotics, 3 RCTs evaluated FMT and one RCT evaluated antibiotics. Probiotics and synbiotics were associated with a significantly reduction in alanine aminotransferase [ALT, (MD: −5.09; 95%CI: −9.79, −0.39), (MD: −7.38, 95CI%: −11.94, −2.82)] and liver stiffness measurement by elastograph [LSM, (MD: −0.37;95%CI: −0.49, −0.25), (MD: −1.00;95%CI: −1.59, −0.41)]. In addition to, synbiotics was superior to probiotics in reducing LSM. Synbiotics was associated with a significant reduction of Controlled Attenuation Parameter [CAP, (MD: −39.34; 95%CI: −74.73, −3.95)]. Both probiotics and synbiotics were associated with a significant reduction of aspartate transaminase [AST, (MD: −7.81; 95%CI: −15.49, −0.12), (MD: −13.32; 95%CI: −23, −3.64)]. Probiotics and Allogenic FMT was associated with a significant reduction of Homeostatic Model Assessment for Insulin Resistance [HOMA-IR, (MD: −0.7, 95%CI: −1.26, −0.15), (MD: −1.8, 95%CI: −3.53, − 0.07)]. Probiotics was associated with a significant reduction of body mass index [BMI, MD: −1.84, 95%CI: −3.35, −0.33].ConclusionThe supplement of synbiotics and probiotics maybe a promising way to improve liver-enzyme, LSM, and steatosis in patients with NAFLD. More randomized controlled trials are needed to determine the efficacy of FMT and antibiotics on NAFLD. And the incidence of adverse events of MTTs should be further explored.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, CRD42023450093.https://www.frontiersin.org/articles/10.3389/fnut.2024.1470185/fullnon-alcoholic fatty liver diseasemicrobiome-targeted therapiesnetwork meta-analysisfecal microbiota transplantantibioticsprobiotics
spellingShingle Yijia Song
Yijia Song
Yijia Song
Sutong Liu
Lihui Zhang
Lihui Zhang
Wenxia Zhao
Yuanmei Qin
Yuanmei Qin
Minghao Liu
The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis
Frontiers in Nutrition
non-alcoholic fatty liver disease
microbiome-targeted therapies
network meta-analysis
fecal microbiota transplant
antibiotics
probiotics
title The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis
title_full The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis
title_fullStr The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis
title_full_unstemmed The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis
title_short The effect of gut microbiome-targeted therapies in nonalcoholic fatty liver disease: a systematic review and network meta-analysis
title_sort effect of gut microbiome targeted therapies in nonalcoholic fatty liver disease a systematic review and network meta analysis
topic non-alcoholic fatty liver disease
microbiome-targeted therapies
network meta-analysis
fecal microbiota transplant
antibiotics
probiotics
url https://www.frontiersin.org/articles/10.3389/fnut.2024.1470185/full
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