Abstract:
Background: Non-Alcoholic Fatty Liver Disease (NAFLD) in childhood is an increasing public health issue globally 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 synthesise all the available literature on the use of probiotics in children and adolescents with NAFLD. Methods: We systematically searched PubMed, EBSCOhost, Scopus, Web of Science, and Cochrane Library 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: 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 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.
