Review Article

Can Bugs be Drugs? The Potential of Probiotics and Prebiotics as Treatment for Non-alcoholic Fatty Liver Disease

Nienke Koopman; Antonio Molinaro; Max Nieuwdorp; Adriaan G. Holleboom


Aliment Pharmacol Ther. 2019;50(6):628-639. 

In This Article


Taken together, the gut microbiota should be considered as a new potential target for the treatment of NAFLD-NASH. Strategies to modulate the gut microbiota with pre-, pro and synbiotics are the most promising for a widespread use (Figure 1). An overview of the main results of the in this review included studies supplementing pro-, pre- and synbiotics in NAFLD-NASH patients can be found in Table 1. However, treating NAFLD-NASH patients with microbiota-oriented therapies is quite new and data is only available from small studies. Therefore, data from larger studies are required.

Figure 1.

Summary of the proposed effect of pro-, pre- and synbiotics in non-alcoholic fatty liver disease. Administration of pro-, pre- and synbiotics is shown to have beneficial effects on different mechanisms underlying NAFLD-NASH pathogenesis. Increased levels of endotoxemia and other hepatotoxins, due to an increase in intestinal permeability have been shown to be associated with NAFLD-NASH pathogenesis. Treatment with pro, pre- and synbiotics is shown to improve this and several other features of NAFLD-NASH by targeting them and by decreasing energy uptake from diet