Probiotics and synbiotics in MASLD/NAFLD: meta-analysis of 30 RCTs
Probiotics and synbiotics reduced ALT, AST, and TNF-α in MASLD/NAFLD patients, with limited effect on triglycerides and insulin resistance.
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What the study showed
The meta-analysis of 30 RCTs (n=1,516) showed statistically significant reductions in ALT, AST, TNF-α, fasting plasma glucose, total cholesterol, and HDL-C. Effects on triglycerides and HOMA-IR did not reach global significance. Subgroups under 50 years, Asian cohorts, and short-to-medium-term interventions showed more pronounced metabolic benefits.
How it was done
Systematic review and meta-analysis of RCTs published up to June 2026, searched across PubMed, Web of Science, Embase, and Cochrane Library. Effect sizes (MD/SMD) were pooled using RevMan 5.3 and Stata 17.0; heterogeneity was assessed via subgroup analyses and the GRADE system.
Risk of bias
Substantial inter-study heterogeneity is acknowledged by the authors as a primary concern, limiting the generalizability of pooled estimates. The abstract does not specify strains, doses, or intervention durations, preventing conclusions about optimal formulations.
What this study does NOT prove
It cannot be concluded that probiotics or synbiotics reverse hepatic fibrosis, prevent progression to MASH, or reduce hard clinical outcomes in MASLD.
In clinical practice
Findings suggest a modest adjunctive benefit on hepatic and inflammatory markers, but high variability across studies warrants caution before translating results to clinical protocols. Routine clinical use cannot be recommended based on this meta-analysis alone.
Limitations
Substantial inter-study heterogeneity is acknowledged by the authors as a primary concern, limiting the generalizability of pooled estimates. The abstract does not specify strains, doses, or intervention durations, preventing conclusions about optimal formulations.
Technical appendix
Version history
- 1.0 · 2026-09-10 — Auto-generated under Evidence Standard v1.0
Paid access: structured summary from public metadata; consult the original study at the source.