Efficacy of Synbiotics in the Management of Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most prevalent chronic liver disease globally, affecting approximately 25% of adults. The gut-liver axis plays a critical role in the pathogenesis of NAFLD, with emerging evidence supporting the therapeutic potential of synbiotics.

Objective: This meta-analysis aimed to evaluate the efficacy of synbiotics in improving hepatic biomarkers, lipid profiles, inflammatory markers, and insulin resistance in patients with NAFLD.

Methods: We systematically searched PubMed, Cochrane Library, and Google Scholar for randomized controlled trials (RCTs) from January 2011 to May 2024. Studies involving patients with NAFLD or non-alcoholic steatohepatitis (NASH) treated with synbiotics were included. Outcome measures were alanine transaminase (ALT), aspartate transaminase (AST), lipid profile, TNF-α, and HOMA-IR. Data were pooled using RevMan 5.3, and heterogeneity was assessed using the I² statistic.

Results: Sixteen RCTs (n = 1248) met inclusion criteria. Synbiotic supplementation significantly reduced ALT (SMD: –0.48; 95% CI: –0.72 to –0.23), AST (SMD: –0.35; 95% CI: –0.59 to –0.12), LDL (mean difference: –16.2 mg/dL), TNF-α (SMD: –0.86), and HOMA-IR (SMD: –0.28). Several studies also reported improvements in steatosis grade and fibrosis on imaging.

Conclusion: Synbiotics significantly improve liver enzyme levels, lipid profiles, inflammatory status, and insulin sensitivity in NAFLD patients. They may serve as effective adjunctive therapy alongside lifestyle and pharmacological interventions.