{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:26:35Z","timestamp":1787667995253,"version":"build-2736575974"},"reference-count":75,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100010216","name":"Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences","doi-asserted-by":"publisher","award":["68235"],"award-info":[{"award-number":["68235"]}],"id":[{"id":"10.13039\/501100010216","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Med Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>MASLD is the most common chronic liver disease and the leading cause of liver-related morbidity and mortality globally. While probiotic supplementations show promise as adjunctive therapy, existing trials are limited by the quality of evidence, small sample sizes, and methodological inconsistencies, highlighting the need for well-designed studies, particularly on multi-strain synbiotics. Therefore, we conducted this trial to evaluate the effects of multi-strain synbiotic combined with lifestyle modifications, including an individualized diet and physical activity program, on patients with MASLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this randomized, double-blinded, placebo-controlled trial, 80 MASLD patients were enrolled and underwent lifestyle modifications. Participants were randomized in a 1:1 ratio to receive either synbiotic capsules (500 mg each, 10\n                      <jats:sup>9<\/jats:sup>\n                      CFU per capsule) containing two strains of\n                      <jats:italic>Bifidobacteria<\/jats:italic>\n                      , two strains of\n                      <jats:italic>Lacticaseibacillus<\/jats:italic>\n                      , two strains of\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      , and one strain of\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      , as well as Fructooligosaccharides as prebiotic, or placebo (one capsule every 12 h) for 12 weeks. All patients were evaluated both at the beginning and the end of the trial in terms of anthropometric parameters (weight, BMI, and WC), hematological parameters (Hb and Plt), coagulation status (PT and INR), lipid profile (TG, TC, HDL-C, and LDL-C), FBS, liver function (ALT and AST), and liver inflammatory biomarkers (TNF-\u03b1 and IL-6).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No significant changes were observed in anthropometric measures either within or between groups during the study period. Moreover, analysis of venous blood samples at the end of the trial showed significant improvements in some measures of lipid profile (TC and LDL-C), FBS, liver function (ALT and AST), and liver inflammatory biomarkers (TNF-\u03b1 and IL-6) in the synbiotics-receiving group compared to both the beginning of the trial and the placebo-receiving group. However, no significant changes were observed in hematological parameters (Hb and Plt), coagulation status (PT and INR), and lipid profile (TG and HDL-C) compared to the beginning of the trial and the placebo-receiving group. Supplements were tolerated well, with no complications or allergic reactions reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Supplementation with multi-strain synbiotics, in combination with lifestyle modifications, could serve as a promising adjunctive therapy to control disease progression in patients with MASLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40001-026-03901-3","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T02:55:38Z","timestamp":1769741738000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Multi-strain synbiotic and lifestyle modifications on patients with metabolic dysfunction-associated steatotic liver disease (MASLD): a randomized double-blinded placebo-controlled trial"],"prefix":"10.1186","volume":"31","author":[{"given":"Masoud","family":"Faghieh Dinavari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samaneh","family":"Abbasian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirreza","family":"Jabbaripour Sarmadian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahereh","family":"Vaezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayyebeh","family":"Vaezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinab","family":"Nikniaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2200-7997","authenticated-orcid":false,"given":"Ali","family":"Riazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"3901_CR1","doi-asserted-by":"crossref","unstructured":"Younossi ZM, Kalligeros M, Henry L. Epidemiology of metabolic dysfunction associated steatotic liver disease. Clin Mol Hepatol. 2024.","DOI":"10.1016\/j.metabol.2024.156004"},{"issue":"6","key":"3901_CR2","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1097\/HEP.0000000000000520","volume":"78","author":"ME Rinella","year":"2023","unstructured":"Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966\u201386.","journal-title":"Hepatology"},{"key":"3901_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jlr.2023.100485","author":"ME Rinella","year":"2024","unstructured":"Rinella ME, Sookoian S. From NAFLD to MASLD: updated naming and diagnosis criteria for fatty liver disease. J Lipid Res. 2024. https:\/\/doi.org\/10.1016\/j.jlr.2023.100485.","journal-title":"J Lipid Res"},{"key":"3901_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2024.02.007","author":"L Miao","year":"2024","unstructured":"Miao L, Targher G, Byrne CD, Cao Y-Y, Zheng M-H. Current status and future trends of the global burden of MASLD. Trends Endocrinol Metab. 2024. https:\/\/doi.org\/10.1016\/j.tem.2024.02.007.","journal-title":"Trends Endocrinol Metab"},{"key":"3901_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejim.2024.01.038","volume":"122","author":"KJ van Erpecum","year":"2024","unstructured":"van Erpecum KJ, Dalekos GN. New horizons in the diagnosis and management of patients with MASLD. Eur J Intern Med. 2024;122:1\u20132.","journal-title":"Eur J Intern Med"},{"key":"3901_CR6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ejim.2023.11.005","volume":"122","author":"V Lekakis","year":"2024","unstructured":"Lekakis V, Papatheodoridis GV. Natural history of metabolic dysfunction-associated steatotic liver disease. Eur J Intern Med. 2024;122:3\u201310.","journal-title":"Eur J Intern Med"},{"key":"3901_CR7","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1421386","volume":"11","author":"M-j Chen","year":"2025","unstructured":"Chen M-j, Chen Y, Lin J-q, Hu R, Liu D, Chen J-y, et al. Evidence summary of lifestyle interventions in adults with metabolic dysfunction-associated steatotic liver disease. Front Nutr. 2025;11:1421386.","journal-title":"Front Nutr"},{"issue":"3","key":"3901_CR8","doi-asserted-by":"publisher","first-page":"818","DOI":"10.7150\/ijbs.56214","volume":"17","author":"A Khan","year":"2021","unstructured":"Khan A, Ding Z, Ishaq M, Bacha AS, Khan I, Hanif A, et al. Understanding the effects of gut microbiota dysbiosis on nonalcoholic fatty liver disease and the possible probiotics role: recent updates. Int J Biol Sci. 2021;17(3):818.","journal-title":"Int J Biol Sci"},{"issue":"7","key":"3901_CR9","doi-asserted-by":"publisher","DOI":"10.3390\/metabo14070366","volume":"14","author":"NG Vallianou","year":"2024","unstructured":"Vallianou NG, Kounatidis D, Psallida S, Vythoulkas-Biotis N, Adamou A, Zachariadou T, et al. NAFLD\/MASLD and the gut\u2013liver axis: from pathogenesis to treatment options. Metabolites. 2024;14(7):366.","journal-title":"Metabolites"},{"key":"3901_CR10","doi-asserted-by":"crossref","unstructured":"Li X, Yu L, Peng Z, Lv T, Li H. Potential probiotics for the therapy of metabolic dysfunction-associated steatotic liver disease. 2025.","DOI":"10.5772\/intechopen.1009922"},{"key":"3901_CR11","doi-asserted-by":"publisher","DOI":"10.1007\/s13167-025-00398-4","author":"S Wang","year":"2025","unstructured":"Wang S, Zhang R, Guo P, Yang H, Liu Y, Zhu H. Association of prebiotic\/probiotic intake with MASLD: evidence from NHANES and randomized controlled trials in the context of prediction, prevention, and a personalized medicine framework. EPMA J. 2025. https:\/\/doi.org\/10.1007\/s13167-025-00398-4.","journal-title":"EPMA J"},{"issue":"15","key":"3901_CR12","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23158805","volume":"23","author":"RZ Carpi","year":"2022","unstructured":"Carpi RZ, Barbalho SM, Sloan KP, Laurindo LF, Gonzaga HF, Grippa PC, et al. The effects of probiotics, prebiotics and synbiotics in non-alcoholic fat liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): a systematic review. Int J Mol Sci. 2022;23(15):8805.","journal-title":"Int J Mol Sci"},{"issue":"4","key":"3901_CR13","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000032734","volume":"102","author":"X Zhou","year":"2023","unstructured":"Zhou X, Wang J, Zhou S, Liao J, Ye Z, Mao L. Efficacy of probiotics on nonalcoholic fatty liver disease: a meta-analysis. Medicine. 2023;102(4):e32734.","journal-title":"Medicine"},{"issue":"10","key":"3901_CR14","doi-asserted-by":"publisher","first-page":"1682","DOI":"10.1111\/jgh.16256","volume":"38","author":"L Rong","year":"2023","unstructured":"Rong L, Ch\u2019ng D, Jia P, Tsoi KK, Wong SH, Sung JJ. Use of probiotics, prebiotics, and synbiotics in non\u2010alcoholic fatty liver disease: a systematic review and meta\u2010analysis. J Gastroenterol Hepatol. 2023;38(10):1682\u201394.","journal-title":"J Gastroenterol Hepatol"},{"issue":"1","key":"3901_CR15","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-024-03356-y","volume":"24","author":"Y Pan","year":"2024","unstructured":"Pan Y, Yang Y, Wu J, Zhou H, Yang C. Efficacy of probiotics, prebiotics, and synbiotics on liver enzymes, lipid profiles, and inflammation in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials. BMC Gastroenterol. 2024;24(1):283.","journal-title":"BMC Gastroenterol"},{"key":"3901_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2024.107398","author":"V Musazadeh","year":"2024","unstructured":"Musazadeh V, Assadian K, Rajabi F, Faghfouri AH, Soleymani Y, Kavyani Z, et al. The effect of synbiotics on liver enzymes, obesity indices, blood pressure, lipid profile, and inflammation in patients with non-alcoholic fatty liver: a systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2024. https:\/\/doi.org\/10.1016\/j.phrs.2024.107398.","journal-title":"Pharmacol Res"},{"key":"3901_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2024.108780","author":"S Mozaffari","year":"2024","unstructured":"Mozaffari S, Aliari M, Emamgholipour S, Hosseini H, Amirkiasar PR, Zare M, et al. The effect of probiotic consumption on lipid profile, glycemic index, inflammatory markers, and liver function in NAFLD patients: a systematic review and meta-analysis of randomized controlled trials. J Diabetes Complications. 2024. https:\/\/doi.org\/10.1016\/j.jdiacomp.2024.108780.","journal-title":"J Diabetes Complications"},{"key":"3901_CR18","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.844242","volume":"9","author":"V Musazadeh","year":"2022","unstructured":"Musazadeh V, Roshanravan N, Dehghan P, Ahrabi SS. Effect of probiotics on liver enzymes in patients with non-alcoholic fatty liver disease: an umbrella of systematic review and meta-analysis. Front Nutr. 2022;9:844242.","journal-title":"Front Nutr"},{"issue":"6","key":"3901_CR19","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1093\/nutrit\/nuad086","volume":"82","author":"E Amini-Salehi","year":"2024","unstructured":"Amini-Salehi E, Hassanipour S, Keivanlou M-H, Shahdkar M, Orang Goorabzarmakhi M, Vakilpour A, et al. The impact of gut microbiome-targeted therapy on liver enzymes in patients with nonalcoholic fatty liver disease: an umbrella meta-analysis. Nutr Rev. 2024;82(6):815\u201330.","journal-title":"Nutr Rev"},{"issue":"8","key":"3901_CR20","doi-asserted-by":"publisher","first-page":"4714","DOI":"10.1097\/MS9.0000000000002276","volume":"86","author":"G Maddineni","year":"2024","unstructured":"Maddineni G, Obulareddy SJ, Paladiya RD, Korsapati RR, Jain S, Jeanty H, et al. The role of gut microbiota augmentation in managing non-alcoholic fatty liver disease: an in-depth umbrella review of meta-analyses with grade assessment. Ann Med Surg. 2024;86(8):4714\u201331.","journal-title":"Ann Med Surg"},{"issue":"6","key":"3901_CR21","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/01.mcg.0000165671.25272.0f","volume":"39","author":"C Loguercio","year":"2005","unstructured":"Loguercio C, Federico A, Tuccillo C, Terracciano F, D\u2019Auria MV, De Simone C, et al. Beneficial effects of a probiotic VSL# 3 on parameters of liver dysfunction in chronic liver diseases. J Clin Gastroenterol. 2005;39(6):540\u20133.","journal-title":"J Clin Gastroenterol"},{"issue":"2","key":"3901_CR22","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1111\/apt.17846","volume":"59","author":"R Loomba","year":"2024","unstructured":"Loomba R, Wong VWS. Implications of the new nomenclature of steatotic liver disease and definition of metabolic dysfunction\u2010associated steatotic liver disease. Aliment Pharmacol Ther. 2024;59(2):150\u20136.","journal-title":"Aliment Pharmacol Ther"},{"issue":"2","key":"3901_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.08.026","volume":"80","author":"H Hagstr\u00f6m","year":"2024","unstructured":"Hagstr\u00f6m H, Vessby J, Ekstedt M, Shang Y. 99% of patients with NAFLD meet MASLD criteria and natural history is therefore identical. J Hepatol. 2024;80(2):e76-e7.","journal-title":"J Hepatol"},{"key":"3901_CR24","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1411802","volume":"11","author":"H Zou","year":"2024","unstructured":"Zou H, Ma X, Pan W, Xie Y. Comparing similarities and differences between NAFLD, MAFLD, and MASLD in the general US population. Front Nutr. 2024;11:1411802.","journal-title":"Front Nutr"},{"issue":"2","key":"3901_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.07.031","volume":"80","author":"A De","year":"2024","unstructured":"De A, Bhagat N, Mehta M, Taneja S, Duseja A. Metabolic dysfunction-associated steatotic liver disease (MASLD) definition is better than MAFLD criteria for lean patients with NAFLD. J Hepatol. 2024;80(2):e61-e2.","journal-title":"J Hepatol"},{"key":"3901_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.155835","author":"M Kokkorakis","year":"2024","unstructured":"Kokkorakis M, Boutari C, Hill MA, Kotsis V, Loomba R, Sanyal AJ, et al. Resmetirom, the first approved drug for the management of metabolic dysfunction-associated steatohepatitis: trials, opportunities, and challenges. Metabolism. 2024. https:\/\/doi.org\/10.1016\/j.metabol.2024.155835.","journal-title":"Metabolism"},{"issue":"11","key":"3901_CR27","doi-asserted-by":"publisher","DOI":"10.3390\/antiox13111386","volume":"13","author":"E Scarpellini","year":"2024","unstructured":"Scarpellini E, Scarcella M, Tack JF, Scarlata GGM, Zanetti M, Abenavoli L. Gut microbiota and metabolic dysfunction-associated steatotic liver disease. Antioxidants. 2024;13(11):1386.","journal-title":"Antioxidants"},{"issue":"1","key":"3901_CR28","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3390\/livers5010011","volume":"5","author":"F Abdelhameed","year":"2025","unstructured":"Abdelhameed F, Mustafa A, Kite C, Lagojda L, Dallaway A, Than NN, et al. Gut microbiota and metabolic dysfunction-associated steatotic liver disease (MASLD): emerging pathogenic mechanisms and therapeutic implications. Livers. 2025;5(1):11.","journal-title":"Livers"},{"key":"3901_CR29","doi-asserted-by":"publisher","DOI":"10.1172\/JCI186423","author":"B Schnabl","year":"2025","unstructured":"Schnabl B, Damman CJ, Carr RM. Metabolic dysfunction\u2013associated steatotic liver disease and the gut microbiome: pathogenic insights and therapeutic innovations. J Clin Invest. 2025. https:\/\/doi.org\/10.1172\/JCI186423.","journal-title":"J Clin Invest"},{"issue":"11","key":"3901_CR30","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1038\/s41575-020-0344-2","volume":"17","author":"KS Swanson","year":"2020","unstructured":"Swanson KS, Gibson GR, Hutkins R, Reimer RA, Reid G, Verbeke K, et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics. Nat Rev Gastroenterol Hepatol. 2020;17(11):687\u2013701.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"3901_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.eujim.2023.102272","volume":"62","author":"YY Fei","year":"2023","unstructured":"Fei YY, Steen J, Tutt E, Ng JY, Dobbins M. The impact of knowledge and attitudes on physicians\u2019, nurses\u2019 and pharmacists\u2019 recommendation of probiotics: a systematic review. Eur J Integr Med. 2023;62:102272.","journal-title":"Eur J Integr Med"},{"issue":"2","key":"3901_CR32","first-page":"27","volume":"3","author":"P Habibollahi","year":"2021","unstructured":"Habibollahi P, Vahdati SS, Asenjan MR, Pahlevan S, Sarmad\u0131an AJ, Om\u0131d\u0131 S. Level of knowledge and attitude of the medical educated people about medicinal herbs. Eurasian J Toxicol. 2021;3(2):27\u201331.","journal-title":"Eurasian J Toxicol"},{"issue":"6","key":"3901_CR33","doi-asserted-by":"publisher","DOI":"10.1002\/mco2.420","volume":"4","author":"J Ji","year":"2023","unstructured":"Ji J, Jin W, Liu SJ, Jiao Z, Li X. Probiotics, prebiotics, and postbiotics in health and disease. MedComm. 2023;4(6):e420.","journal-title":"MedComm"},{"issue":"22","key":"3901_CR34","doi-asserted-by":"publisher","first-page":"3955","DOI":"10.3390\/nu16223955","volume":"16","author":"N Al-Habsi","year":"2024","unstructured":"Al-Habsi N, Al-Khalili M, Haque SA, Elias M, Olqi NA, Al Uraimi T. Health benefits of prebiotics, probiotics, synbiotics, and postbiotics. Nutrients. 2024;16(22):3955.","journal-title":"Nutrients"},{"issue":"1","key":"3901_CR35","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s12876-023-02760-0","volume":"23","author":"M Faghih Dinevari","year":"2023","unstructured":"Faghih Dinevari M, Jafarzadeh F, Jabbaripour Sarmadian A, Abbasian S, Nikniaz Z, Riazi A. The effect of melatonin on irritable bowel syndrome patients with and without sleep disorders: a randomized double-blinded placebo-controlled trial study. BMC Gastroenterol. 2023;23(1):135.","journal-title":"BMC Gastroenterol"},{"key":"3901_CR36","doi-asserted-by":"publisher","DOI":"10.1002\/tkm2.70004","author":"M Faghieh Dinavari","year":"2025","unstructured":"Faghieh Dinavari M, Nazemiyeh H, Somi MH, Jabbaripour Sarmadian A, Riazi A, Abbasian S, et al. Punica granatum peel extract on irritable bowel syndrome patients with predominant diarrhea: a randomized double\u2010blinded placebo\u2010controlled trial study. Trad Kampo Med. 2025. https:\/\/doi.org\/10.1002\/tkm2.70004.","journal-title":"Trad Kampo Med"},{"issue":"7","key":"3901_CR37","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1002\/ueg2.12636","volume":"12","author":"MM Estevinho","year":"2024","unstructured":"Estevinho MM, Yuan Y, Rodr\u00edguez-Lago I, Sousa-Pimenta M, Dias CC, Barreiro-de Acosta M, et al. Efficacy and safety of probiotics in IBD: An overview of systematic reviews and updated meta-analysis of randomized controlled trials. United Eur Gastroenterol J. 2024;12(7):960\u201381.","journal-title":"United Eur Gastroenterol J"},{"issue":"4","key":"3901_CR38","doi-asserted-by":"publisher","first-page":"289","DOI":"10.2174\/0115748936302814240729062857","volume":"20","author":"A Shahriari","year":"2025","unstructured":"Shahriari A, Shams SA, Mahboobi H, Yazdanparast M, Sarmadian AJ. Mining transcriptional data for precision medicine: bioinformatics insights into inflammatory bowel disease. Curr Bioinform. 2025;20(4):289\u201398.","journal-title":"Curr Bioinform"},{"issue":"4","key":"3901_CR39","first-page":"348","volume":"67","author":"T Falalyeyeva","year":"2021","unstructured":"Falalyeyeva T, Mamula Y, Scarpellini E, Leshchenko I, Humeniuk A, Pankiv I, et al. Probiotics and obesity associated disease: an extended view beyond traditional strains. Minerva Gastroenterol. 2021;67(4):348\u201356.","journal-title":"Minerva Gastroenterol"},{"issue":"1","key":"3901_CR40","doi-asserted-by":"publisher","DOI":"10.3390\/nu17010052","volume":"17","author":"A L\u00f3pez-Yerena","year":"2024","unstructured":"L\u00f3pez-Yerena A, de Santisteban Villaplana V, Badimon L, Vilahur G, Padro T. Probiotics: a potential strategy for preventing and managing cardiovascular disease. Nutrients. 2024;17(1):52.","journal-title":"Nutrients"},{"issue":"1","key":"3901_CR41","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s40360-024-00773-3","volume":"25","author":"J Houshyar","year":"2024","unstructured":"Houshyar J, Hashemzadeh N, Khoubnasabjafari M, Sarmadian AJ, Jouyban-Gharamaleki V, Mogaddam MRA, et al. A cross-sectional study on metoprolol concentrations in various biological samples and their inter-correlations. BMC Pharmacol Toxicol. 2024;25(1):45.","journal-title":"BMC Pharmacol Toxicol"},{"key":"3901_CR42","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.clnesp.2023.11.003","volume":"59","author":"J Lou","year":"2024","unstructured":"Lou J, Cui S, Huang N, Jin G, Chen C, Fan Y, et al. Efficacy of probiotics or synbiotics in critically ill patients: a systematic review and meta-analysis. Clin Nutr ESPEN. 2024;59:48\u201362.","journal-title":"Clin Nutr ESPEN"},{"issue":"2","key":"3901_CR43","doi-asserted-by":"publisher","first-page":"140","DOI":"10.2174\/0115734013295502240604074931","volume":"21","author":"S Fatemizadeh","year":"2025","unstructured":"Fatemizadeh S, Mahboobi H, Moghtadaie A, Sarmadian AJ, Kamal MA. Enteral feeding dilemmas: navigating the impact of bacterial contamination in hospitalized populations. Curr Nutr Food Sci. 2025;21(2):140\u20137.","journal-title":"Curr Nutr Food Sci"},{"key":"3901_CR44","doi-asserted-by":"publisher","DOI":"10.1016\/j.medmic.2024.100111","author":"S Mukherjee","year":"2024","unstructured":"Mukherjee S, Kumar D, Guha D. Insights of probiotics as an alternative medicine for cancer therapy, mechanism, and applications. Med Microecol. 2024. https:\/\/doi.org\/10.1016\/j.medmic.2024.100111.","journal-title":"Med Microecol"},{"issue":"12","key":"3901_CR45","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms9122415","volume":"9","author":"S Saturio","year":"2021","unstructured":"Saturio S, Nogacka AM, Alvarado-Jasso GM, Salazar N, de Los Reyes-Gavil\u00e1n CG, Gueimonde M, et al. Role of bifidobacteria on infant health. Microorganisms. 2021;9(12):2415.","journal-title":"Microorganisms"},{"issue":"10","key":"3901_CR46","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1016\/j.tim.2022.04.004","volume":"30","author":"M Derrien","year":"2022","unstructured":"Derrien M, Turroni F, Ventura M, van Sinderen D. Insights into endogenous Bifidobacterium species in the human gut microbiota during adulthood. Trends Microbiol. 2022;30(10):940\u20137.","journal-title":"Trends Microbiol"},{"issue":"2","key":"3901_CR47","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2023.2291164","volume":"15","author":"SJ Gavzy","year":"2023","unstructured":"Gavzy SJ, Kensiski A, Lee ZL, Mongodin EF, Ma B, Bromberg JS. Bifidobacterium mechanisms of immune modulation and tolerance. Gut Microbes. 2023;15(2):2291164.","journal-title":"Gut Microbes"},{"issue":"2","key":"3901_CR48","doi-asserted-by":"publisher","DOI":"10.3390\/life14020239","volume":"14","author":"GH Hizo","year":"2024","unstructured":"Hizo GH, Rampelotto PH. The impact of probiotic Bifidobacterium on liver diseases and the microbiota. Life. 2024;14(2):239.","journal-title":"Life"},{"issue":"5","key":"3901_CR49","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1016\/j.chom.2022.03.002","volume":"30","author":"LM Olsson","year":"2022","unstructured":"Olsson LM, Boulund F, Nilsson S, Khan MT, Gummesson A, Fagerberg L, et al. Dynamics of the normal gut microbiota: a longitudinal one-year population study in Sweden. Cell Host Microbe. 2022;30(5):726\u201339.","journal-title":"Cell Host Microbe"},{"issue":"12","key":"3901_CR50","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms11122999","volume":"11","author":"GH Hizo","year":"2023","unstructured":"Hizo GH, Rampelotto PH. The role of Bifidobacterium in liver diseases: a systematic review of next-generation sequencing studies. Microorganisms. 2023;11(12):2999.","journal-title":"Microorganisms"},{"issue":"13","key":"3901_CR51","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26135944","volume":"26","author":"K-S Chang","year":"2025","unstructured":"Chang K-S, Kuo W-H, Chang M-H, Hsiao Y, Tsai R-Y. Gut microbiota and liver health: meta-analysis of Bifidobacterium-containing probiotics in NAFLD management. Int J Mol Sci. 2025;26(13):5944.","journal-title":"Int J Mol Sci"},{"issue":"4","key":"3901_CR52","doi-asserted-by":"publisher","first-page":"2782","DOI":"10.1099\/ijsem.0.004107","volume":"70","author":"J Zheng","year":"2020","unstructured":"Zheng J, Wittouck S, Salvetti E, Franz CM, Harris HM, Mattarelli P, et al. A taxonomic note on the genus Lactobacillus: description of 23 novel genera, emended description of the genus Lactobacillus Beijerinck 1901, and union of Lactobacillaceae and Leuconostocaceae. Int J Syst Evol Microbiol. 2020;70(4):2782\u2013858.","journal-title":"Int J Syst Evol Microbiol"},{"issue":"12","key":"3901_CR53","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12122382","volume":"12","author":"PB Heczko","year":"2024","unstructured":"Heczko PB, Giemza M, Ponikiewska W, Strus M. Importance of Lactobacilli for human health. Microorganisms. 2024;12(12):2382.","journal-title":"Microorganisms"},{"key":"3901_CR54","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.840245","volume":"13","author":"E Dempsey","year":"2022","unstructured":"Dempsey E, Corr SC. Lactobacillus spp. for gastrointestinal health: current and future perspectives. Front Immunol. 2022;13:840245.","journal-title":"Front Immunol"},{"key":"3901_CR55","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.1042189","volume":"13","author":"S Rastogi","year":"2022","unstructured":"Rastogi S, Singh A. Gut microbiome and human health: exploring how the probiotic genus Lactobacillus modulate immune responses. Front Pharmacol. 2022;13:1042189.","journal-title":"Front Pharmacol"},{"issue":"2","key":"3901_CR56","doi-asserted-by":"publisher","first-page":"288","DOI":"10.3390\/microorganisms10020288","volume":"10","author":"J-J Jeong","year":"2022","unstructured":"Jeong J-J, Park HJ, Cha MG, Park E, Won S-M, Ganesan R, et al. The Lactobacillus as a probiotic: focusing on liver diseases. Microorganisms. 2022;10(2):288.","journal-title":"Microorganisms"},{"key":"3901_CR57","doi-asserted-by":"crossref","unstructured":"Gu M, Hong Q, Cui J, Li W, Zhang J, Sun Y, et al. Harnessing lactobacillus: a probiotic revolution in combating metabolic dysfunction-associated steatotic liver disease. Crit Rev Food Sci Nutr. 2025:1\u201318.","DOI":"10.1080\/10408398.2025.2504162"},{"key":"3901_CR58","doi-asserted-by":"publisher","DOI":"10.1016\/j.crfs.2025.101138","volume":"11","author":"J Lu","year":"2025","unstructured":"Lu J, Dong X, Gao Z, Yan H, Shataer D, Wang L, et al. Probiotics as a therapeutic strategy for metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis. Curr Res Food Sci. 2025;11:101138.","journal-title":"Curr Res Food Sci"},{"issue":"4","key":"3901_CR59","doi-asserted-by":"publisher","DOI":"10.3390\/applmicrobiol5040101","volume":"5","author":"AZ Ghailan","year":"2025","unstructured":"Ghailan AZ, Niamah AK. Streptococcus thermophilus: metabolic properties, functional features, and useful applications. Appl Microbiol. 2025;5(4):101.","journal-title":"Appl Microbiol"},{"issue":"2","key":"3901_CR60","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1080\/87559129.2023.2202406","volume":"40","author":"Y-Y Huang","year":"2024","unstructured":"Huang Y-Y, Lu Y-H, Liu X-T, Wu W-T, Li W-Q, Lai S-Q, et al. Metabolic properties, functional characteristics, and practical application of Streptococcus thermophilus. Food Rev Intl. 2024;40(2):792\u2013813.","journal-title":"Food Rev Intl"},{"issue":"1","key":"3901_CR61","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/S2468-1253(22)00317-X","volume":"8","author":"J Quek","year":"2023","unstructured":"Quek J, Chan KE, Wong ZY, Tan C, Tan B, Lim WH, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20\u201330.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"3901_CR62","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.155937","volume":"157","author":"M Huttasch","year":"2024","unstructured":"Huttasch M, Roden M, Kahl S. Obesity and MASLD: is weight loss the (only) key to treat metabolic liver disease? Metabolism. 2024;157:155937.","journal-title":"Metabolism"},{"issue":"12","key":"3901_CR63","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1007\/s11883-023-01167-2","volume":"25","author":"B Nussbaumerova","year":"2023","unstructured":"Nussbaumerova B, Rosolova H. Obesity and dyslipidemia. Curr Atheroscler Rep. 2023;25(12):947\u201355.","journal-title":"Curr Atheroscler Rep"},{"key":"3901_CR64","doi-asserted-by":"crossref","unstructured":"Jodi S, Separham A, Sarmadian AJ, Rakhsha N. Investigating and comparing the relationship between the SYNTAX score and short-term and long-term consequences of patients with STEMI under thrombolytic treatment and then angiography in the years 2018\u20132020. J Iran Med Council. 2024.","DOI":"10.18502\/jimc.v8i2.17710"},{"issue":"1","key":"3901_CR65","doi-asserted-by":"publisher","DOI":"10.12997\/jla.2025.14.1.5","volume":"14","author":"F Bril","year":"2024","unstructured":"Bril F, Berg G, Barchuk M, Nogueira JP. Practical approaches to managing dyslipidemia in patients with metabolic dysfunction-associated steatotic liver disease. J Lipid Atherosclerosis. 2024;14(1):5.","journal-title":"J Lipid Atherosclerosis"},{"key":"3901_CR66","unstructured":"Pappan N, Awosika AO, Rehman A. Dyslipidemia. StatPearls [Internet]: StatPearls Publishing; 2024."},{"issue":"4","key":"3901_CR67","doi-asserted-by":"publisher","DOI":"10.3390\/diabetology6040023","volume":"6","author":"A Ntikoudi","year":"2025","unstructured":"Ntikoudi A, Papachristou A, Tsalkitzi A, Margari N, Evangelou E, Vlachou E. Metabolic-associated steatotic liver disease (MASLD) and Type 2 diabetes: mechanisms, diagnostic approaches, and therapeutic interventions. Diabetol. 2025;6(4):23.","journal-title":"Diabetol"},{"issue":"1","key":"3901_CR68","doi-asserted-by":"publisher","first-page":"2","DOI":"10.34172\/jrcm.2023.32226","volume":"11","author":"MF Dinevari","year":"2023","unstructured":"Dinevari MF, Abbasian S, Hejazi M, Riazi A. Comparison of liver elastography results in COVID-19 patients with and without increased liver enzymes. J Res Clin Med. 2023;11(1):2.","journal-title":"J Res Clin Med"},{"issue":"1","key":"3901_CR69","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-025-04156-8","volume":"25","author":"M Alnees","year":"2025","unstructured":"Alnees M, Awwad M, Najajra D, Darwish A, Heih O, Al-Ali T, et al. Predictive factors for metabolic syndrome in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). BMC Gastroenterol. 2025;25(1):562.","journal-title":"BMC Gastroenterol"},{"issue":"1","key":"3901_CR70","doi-asserted-by":"publisher","first-page":"23","DOI":"10.34172\/jrcm.2020.023","volume":"8","author":"MF Dinevari","year":"2020","unstructured":"Dinevari MF, Somi MH, Tarzamni MK, Alizadeh L, Abbasian S, Riazi A, et al. The diagnostic value of non-invasive serum liver fibrosis indices in the prediction of portal hypertension in cirrhotic patients: a cross-sectional study. J Res Clin Med. 2020;8(1):23.","journal-title":"J Res Clin Med"},{"issue":"3","key":"3901_CR71","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1007\/s13679-024-00574-z","volume":"13","author":"F Abdelhameed","year":"2024","unstructured":"Abdelhameed F, Kite C, Lagojda L, Dallaway A, Chatha KK, Chaggar SS, et al. Non-invasive scores and serum biomarkers for fatty liver in the era of metabolic dysfunction-associated steatotic liver disease (MASLD): a comprehensive review from NAFLD to MAFLD and MASLD. Curr Obes Rep. 2024;13(3):510\u201331.","journal-title":"Curr Obes Rep"},{"issue":"5","key":"3901_CR72","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines13051260","volume":"13","author":"Y-M Jee","year":"2025","unstructured":"Jee Y-M, Lee J-Y, Ryu T. Chronic inflammation and immune dysregulation in metabolic-dysfunction-associated steatotic liver disease progression: from steatosis to hepatocellular carcinoma. Biomedicines. 2025;13(5):1260.","journal-title":"Biomedicines"},{"issue":"3","key":"3901_CR73","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1017\/S0007114514000919","volume":"112","author":"T Eslamparast","year":"2014","unstructured":"Eslamparast T, Zamani F, Hekmatdoost A, Sharafkhah M, Eghtesad S, Malekzadeh R, et al. Effects of synbiotic supplementation on insulin resistance in subjects with the metabolic syndrome: a randomised, double-blind, placebo-controlled pilot study. Br J Nutr. 2014;112(3):438\u201345.","journal-title":"Br J Nutr"},{"issue":"1","key":"3901_CR74","doi-asserted-by":"publisher","first-page":"48","DOI":"10.34172\/jrcm.2020.048","volume":"8","author":"MH Somi","year":"2020","unstructured":"Somi MH, Dinevari MF, Alizadeh L, Riazi A, Abbasian S, Nikniaz Z. Comparison of the serum fibrinogen level and International Normalized Ratio in the assessment of the risk of gastrointestinal bleeding in decompensated cirrhosis. J Res Clin Med. 2020;8(1):48.","journal-title":"J Res Clin Med"},{"issue":"9","key":"3901_CR75","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.4254\/wjh.v16.i9.1229","volume":"16","author":"OM Fierro-Angulo","year":"2024","unstructured":"Fierro-Angulo OM, Gonz\u00e1lez-Regueiro JA, Pereira-Garc\u00eda A, Ruiz-Marg\u00e1in A, Solis-Huerta F, Mac\u00edas-Rodr\u00edguez RU. Hematological abnormalities in liver cirrhosis. World J Hepatol. 2024;16(9):1229.","journal-title":"World J Hepatol"}],"container-title":["European Journal of Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40001-026-03901-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40001-026-03901-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40001-026-03901-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T13:05:30Z","timestamp":1772024730000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40001-026-03901-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,30]]},"references-count":75,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3901"],"URL":"https:\/\/doi.org\/10.1186\/s40001-026-03901-3","relation":{},"ISSN":["2047-783X"],"issn-type":[{"value":"2047-783X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,30]]},"assertion":[{"value":"28 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed according to the principles outlined by the World Medical Association\u2019s Declaration of Helsinki on experimentation involving human subjects, as revised in 2000, and the study protocol has been approved by the ethics committee of Tabriz University of Medical Sciences with the approval ID IR.TBZMED.REC.1400.1095 on 19\/01\/2022. Patients signed and accepted informed consent papers to participate in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Patients provided written informed consent, granting permission for the publication of their data. They were assured that their participation in this study and the data they provided would remain completely confidential.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"354"}}