Mohamad Hizami MN.1, Nurainina A.2, Nor Hamizah S.1, Norfilza MM. 2,3, Zhiqin W. 1,3, Raja Affendi RA. 1,3, Khairul Najmi MN. 1,3

1Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia, 2Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia, 3GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia

Background/Aims: The gut microbiota forms a part of the gut-liver axis and serve as a potential target for treatment of non-alcoholic fatty liver disease (NAFLD). We aim to investigate whether gut microbiota manipulation using probiotics will result in the improvement of the hepatic steatosis, fibrosis and biochemical blood tests as well as other clinical parameters.

Methods: This was a randomized, double-blind, placebo-controlled trial involving ultrasound-diagnosed NAFLD patients (n=39) who were supplemented with either probiotics or placebo for a total of 24 weeks. We used multi-strain probiotics, containing 6 different Lactobacillus and Bifidobacterium species at the concentration of 30 billion CFU.

Results: Probiotics group (n=17) showed a significant mean reduction of the hepatic steatosis, as measured by controlled attenuation parameter (CAP); mean reduction –21.70 dB/m ± 42.60 (within group p<0.05) as compared to the placebo group (n=22); mean reduction –10.72 dB/m ± 46.64 (within group p=0.45), although the reduction between the two groups was not statistically significant (p=0.45). No significant mean changes were found between probiotics and placebo groups for the following parameters: fibrosis score (in kPa), alanine aminotransferase, total cholesterol, triglycerides and BMI. Significant increase in fasting glucose was found in the probiotics as compared to placebo  group ; 0.48 vs -0.44 mg/dl (p=0.03).

Conclusion: In this pilot study, the use of probiotics resulted in a significant mean reduction of hepatic steatosis. Other clinical outcomes did not show any significant changes at study conclusion. In the future, further studies with bigger sample sizes and longer duration are needed.

Keywords: NAFLD, Probiotics, Gut microbiota, gut-liver axis