The effects of gut microbiome manipulation on glycemic indices in patients with non-alcoholic fatty liver disease: a comprehensive umbrella review

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2024年5月10日

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Azin Vakilpour,
Ehsan Amini-Salehi,
Arman Soltani Moghadam,
Mohammad-Hossein Keivanlou,
Negin Letafatkar,
Arman Habibi,
Mohammad Hashemi,
Negar Eslami,
Reza Zare,
Naeim Norouzi,
Hamed Delam,
Farahnaz Joukar,
Fariborz Mansour-Ghanaei,
Soheil Hassanipour,
Sandeep Samethadka Nayak

摘要

Background

Type 2 diabetes mellitus (T2DM) is a significant risk factor for non-alcoholic fatty liver disease (NAFLD). Increased fasting blood sugar (FBS), fasting insulin (FI), and insulin resistance (HOMA-IR) are observed in patients with NAFLD. Gut microbial modulation using prebiotics, probiotics, and synbiotics has shown promise in NAFLD treatment. This meta-umbrella study aimed to investigate the effects of gut microbial modulation on glycemic indices in patients with NAFLD and discuss potential mechanisms of action.

Methods

A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library until March 2023 for meta-analyses evaluating the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD. Random-effect models, sensitivity analysis, and subgroup analysis were employed.

Results

Gut microbial therapy significantly decreased HOMA-IR (ES: −0.41; 95%CI: −0.52, −0.31; P < 0.001) and FI (ES: −0.59; 95%CI: −0.77, −0.41; P < 0.001). However, no significant effect was observed on FBS (ES: −0.17; 95%CI: −0.36, 0.02; P = 0.082). Subgroup analysis revealed prebiotics had the most potent effect on HOMA-IR, followed by probiotics and synbiotics. For FI, synbiotics had the most substantial effect, followed by prebiotics and probiotics.

Conclusion

Probiotics, prebiotics, and synbiotics administration significantly reduced FI and HOMA-IR, but no significant effect was observed on FBS.