{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:23:47Z","timestamp":1792095827304,"version":"4.4.0"},"reference-count":59,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T00:00:00Z","timestamp":1688601600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Patients with non\u2010alcoholic fatty liver disease (NAFLD) exhibit compositional changes in their gut microbiome, which represents a potential therapeutic target. Probiotics, prebiotics, and synbiotics are microbiome\u2010targeted therapies that have been proposed as treatment for NAFLD. We aim to systematically review the effects of these therapies in liver\u2010related outcomes of NAFLD patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a systematic search in Embase (Ovid), Medline (Ovid), Scopus, Cochrane, and EBSCOhost from inception to August 19, 2022. We included randomized controlled trials (RCTs) that treated NAFLD patients with prebiotics and\/or probiotics. We meta\u2010analyzed the outcomes using standardized mean difference (SMD) and assessed study heterogeneity using Cochran's <jats:italic>Q<\/jats:italic> test and <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> statistics. Risk of bias was assessed using the Cochrane Risk\u2010of\u2010Bias 2 tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 41 (18 probiotics, 17 synbiotics, and 6 prebiotics) RCTs were included. Pooled data demonstrated that the intervention had significantly improved liver steatosis (measured by ultrasound grading) (SMD: 4.87; 95% confidence interval [CI]: 3.27, 7.25), fibrosis (SMD: \u22120.61\u00a0kPa; 95% CI: \u22121.12, \u22120.09\u00a0kPa), and liver enzymes including alanine transaminase (SMD: \u22120.86\u00a0U\/L; 95% CI: \u22121.16, \u22120.56\u00a0U\/L), aspartate transaminase (SMD: \u22120.87\u00a0U\/L; 95% CI: \u22121.22, \u22120.52\u00a0U\/L), and gamma\u2010glutamyl transferase (SMD: \u22120.77\u00a0U\/L; 95% CI: \u22121.26, \u22120.29\u00a0U\/L).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Microbiome\u2010targeted therapies were associated with significant improvements in liver\u2010related outcomes in NAFLD patients. Nevertheless, limitations in existing literature like heterogeneity in probiotic strains, dosage, and formulation undermine our findings. This study was registered with PROSPERO (CRD42022354562) and supported by the Nanyang Technological University Start\u2010up Grant and Wang Lee Wah Memorial Fund.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.16256","type":"journal-article","created":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T09:55:30Z","timestamp":1688637330000},"page":"1682-1694","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Use of probiotics, prebiotics, and synbiotics in non\u2010alcoholic fatty liver disease: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8534-1119","authenticated-orcid":false,"given":"Lim","family":"Rong","sequence":"first","affiliation":[{"name":"Lee Kong Chian School of Medicine Nanyang Technological University  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ch'ng","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine Nanyang Technological University  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingping","family":"Jia","sequence":"additional","affiliation":[{"name":"The Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong  Shatin Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5580-7686","authenticated-orcid":false,"given":"Kelvin K F","family":"Tsoi","sequence":"additional","affiliation":[{"name":"The Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong  Shatin Hong Kong SAR"},{"name":"Stanley Ho Big Data Analytics Research Centre The Chinese University of Hong Kong  Shatin Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3354-9310","authenticated-orcid":false,"given":"Sunny H","family":"Wong","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine Nanyang Technological University  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3125-5199","authenticated-orcid":false,"given":"Joseph J Y","family":"Sung","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine Nanyang Technological University  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"SingHealth.The link between obesity and non\u2010alcoholic fatty liver disease.2017. 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