Year 2023 / Volume 115 / Number 8
Original
Probiotics and non-alcoholic fatty liver disease in children and adolescents: a systematic review

418-427

DOI: 10.17235/reed.2022.8796/2022

David Avelar-Rodríguez, Rubén Peña-Vélez, Jelena Popov, Lee Hill, Paul MacDaragh Ryan,

Abstract
Background: non-alcoholic fatty liver disease (NAFLD) in childhood is an increasing global public health issue with significant long-term consequences. NAFLD management mainly consists of lifestyle modifications, however, adjunct pharmacological therapies are currently lacking. Gut microbiota manipulation via probiotics may alter the course of pediatric NAFLD. The objective of this systematic review was to synthesize all the available literature on the use of probiotics in children and adolescents with NAFLD. Methods: PubMed, EBSCOhost, Scopus, Web of Science, and Cochrane Library were systematically searched for trials on the use of probiotics in pediatric NAFLD. A quantitative DerSimonian Laird random effects meta-analysis was performed when possible; otherwise, a narrative summary of the study outcomes was presented and discussed. A separate search was completed to include all the ongoing registered trials on probiotics use in pediatric NAFLD. Results: five randomized controlled trials met the inclusion criteria. Of these, four trials were included in the final quantitative analysis. Probiotic therapy significantly reduced the levels of alanine aminotransferase (ALT) (mean difference: -10.39 [-19.85, -0.93]), however significant heterogeneity between studies was identified (I2, 93 %). Conclusions: there is insufficient evidence to support probiotics in the treatment of pediatric NAFLD given the substantial degree of discordance amongst the available trials. Lifestyle modifications focusing on maintaining a normal BMI and regular exercise continue to be the gold standard approach to treating NAFLD in children.
Lay Summary
Non-Alcoholic Fatty Liver Disease in childhood is an increasing public health issue globally with significant long-term consequences. Non-Alcoholic Fatty Liver Disease management mainly consists of lifestyle modifications, however, adjunct pharmacological therapies are currently lacking. Gut microbiota manipulation via probiotics may alter the course of pediatric Non-Alcoholic Fatty Liver Disease. 5 randomized controlled trials met the inclusion criteria. Of these, 4 trials were included in the final quantitative analysis. Probiotic therapy significantly reduced the levels of alanine amino transferase (mean difference, -10.39 [-19.85, -0.93]), however significant heterogeneity between studies was identified (I2, 93%). There is insufficient evidence to support probiotics in the treatment of pediatric Non-Alcoholic Fatty Liver Disease given the substantial degree of discordance amongst the available trials. Lifestyle modifications focusing on maintaining a normal body mass index and regular exercise continue to be the gold standard approach to treating Non-Alcoholic Fatty Liver Disease in children.
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09/08/2023 5:18:07
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Avelar-Rodríguez D, Peña-Vélez R, Popov J, Hill L, Ryan P. Probiotics and non-alcoholic fatty liver disease in children and adolescents: a systematic review. 8796/2022


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Publication history

Received: 17/03/2022

Accepted: 08/11/2022

Online First: 22/11/2022

Published: 26/07/2023

Article revision time: 165 days

Article Online First time: 250 days

Article editing time: 496 days


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