Probiotics and Omega-3s for Fatty Liver Cut Steatosis Risk

Damian McNamara

November 02, 2017

BARCELONA — The combination of probiotics and omega-3 fatty acids significantly lowers the risk for steatosis in patients with nonalcoholic fatty liver disease (NAFLD), according to Ukrainian investigators who were able to translate their promising animal findings to the clinical setting.

Preventing and treating NAFLD is "a growing challenge," said Nazarii Kobyliak, MD, from Bogomolets National Medical University in Kiev, Ukraine.

"Several pharmacologic treatments for NAFLD have been proposed, but one of the potential strategies may be manipulation of the gut microbiota," he said here at United European Gastroenterology Week 2017.

To explore this strategy, Dr Kobyliak and his colleagues assessed 48 adults with NAFLD, some of whom had type 2 diabetes.

Twenty-six participants received a combination of probiotics supplemented with flax 250 mg and wheat germ oil 250 mg (each with 1% to 5% omega-3 fatty acids), known as Symbiter Omega, for 8 weeks, and 22 participants received placebo.

The decrease in Fatty Liver Index scores during the study period — one of the primary end points — were significant in the probiotic group but not in the placebo group.

Table. Mean Change in Fatty Liver Index Score From Baseline to 8 Weeks

Treatment Group Baseline Score 8-Week Score Reduction P Value
Probiotic 83.5 76.3 7.2 <.001
Placebo 82.9 81.1 1.8 .156

 

"Our other primary end point — liver stiffness — did not significantly differ between groups," Dr Kobyliak reported.

There was a significant decrease in markers of chronic systemic inflammation — TNF alpha, interleukin (IL)-1β, IL-6, IL-8, interferon gamma — in only some patients in the probiotic group. And there were slight but nonsignificant decreases in body weight and waist circumference in the probiotic group.

Both the probiotic combination and the placebo were well tolerated, and the participants reported only minor adverse events during the study period.

This represents a new branch in the study of NAFLD management.

"This represents a new branch in the study of NAFLD management," said Dr Kobyliak, although he acknowledged that the sample size in this study was small and there was a lack of long-term follow-up.

The findings confirm those from an animal study in which Dr Kobyliak's team showed that the coadministration of probiotics and omega-3 fatty acids reduced liver fat, improved serum lipids, improved the metabolic profile, and reduced chronic systemic inflammatory state (Probiotics Antimicrob Proteins. 2017;9:123-130).

This is "a promising study," said Max Nieuwdorp, MD, PhD, from the Academic Medical Center in Amsterdam. However, "it needs to be reproduced in a study in which people are treated for a longer time."

"What you see is only a difference in some inflammatory markers and liver fat, but you don't see anything happening on liver stiffness," he told Medscape Medical News.

"This is a very small study and it has a few methodological limitations," said Stephan Bischoff, MD, from Hohenheim University in Stuttgart, Germany. But it confirms results from a trial in which a multispecies probiotic, LSV#3, was compared with placebo in 130 hospitalized patients with liver cirrhosis who were followed for 6 months (Gastroenterology. 2014;147:1327-37.e3).

"They had amazing results," said Dr Bischoff. "It was a randomized controlled trial with a larger number of patients and a clear outcome."

On the basis of this research, Dr Kobyliak won the National Scholar Award at the meeting, which recognizes the most promising investigator younger than 35 from each country.

Dr Kobyliak. Dr Nieuwdorp, and Dr Bischoff have disclosed no relevant financial relationships.

United European Gastroenterology (UEG) Week 2017. Presented November 1, 2017.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Damian McNamara @MedReporter

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