title: Probiotics as a complementary therapeutic approach in nonalcoholic fatty liver disease.
abstract: Nonalcoholic fatty liver disease (NAFLD) is currently recognized as one of the most common causes of chronic liver disease. It involves a spectrum of conditions that include pure steatosis without inflammation, steatohepatitis, fibrosis and cirrhosis. The key factor in the pathophysiology of NAFLD is insulin resistance that determines lipid accumulation in the hepatocytes and, thus, oxidative stress, which is followed by inflammatory response. However, NAFLD pathogenesis is still largely unknown and has been extensively investigated. Although life style modification with the aim of losing weight has been advocated to treat this disorder, its effectiveness is limited; additionally, there is no specific pharmacologic treatment until nowadays. Recent evidence suggests that the gut microbiota may play a role in the development of insulin resistance, hepatic steatosis, necroinflammation and fibrosis. Differences in gut microbiota between NAFLD patients and lean individuals as well as presence of small intestinal bacterial overgrowth in NAFLD subjects have been demonstrated. Furthermore, some data indicate that the immunoregulatory effects of probiotics may be beneficial in NAFLD treatment as they modulate the intestinal microbiota; improve epithelial barrier function and strengthen the intestinal wall decreasing its permeability; reduce bacterial translocation and endotoxemia; improve intestinal inflammation; and reduce oxidative and inflammatory liver damage. In this article, we review the clinical trials on the use of probiotics in the treatment of NAFLD and discuss the effects of these agents and their efficacy as an emerging therapeutic resource to treat NAFLD patients.
authors.affiliation: Silvia Marinho Ferolla, Geyza Nogueira de Almeida Armiliato, Cláudia Alves Couto, Teresa Cristina Abreu Ferrari, Departamento de Clínica Médica, Centro de Pós-Graduação, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100 Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Silvia Marinho
authors.initials: SM
authors.lastname: Ferolla
authors.affiliation: Silvia Marinho Ferolla, Geyza Nogueira de Almeida Armiliato, Cláudia Alves Couto, Teresa Cristina Abreu Ferrari, Departamento de Clínica Médica, Centro de Pós-Graduação, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100 Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Geyza Nogueira de Almeida
authors.initials: GN
authors.lastname: Armiliato
authors.affiliation: Silvia Marinho Ferolla, Geyza Nogueira de Almeida Armiliato, Cláudia Alves Couto, Teresa Cristina Abreu Ferrari, Departamento de Clínica Médica, Centro de Pós-Graduação, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100 Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Cláudia Alves
authors.initials: CA
authors.lastname: Couto
authors.affiliation: Silvia Marinho Ferolla, Geyza Nogueira de Almeida Armiliato, Cláudia Alves Couto, Teresa Cristina Abreu Ferrari, Departamento de Clínica Médica, Centro de Pós-Graduação, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100 Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Teresa Cristina Abreu
authors.initials: TC
authors.lastname: Ferrari
keywords: Fatty liver; Intestinal microbiota; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Probiotic
references.citation: Am J Clin Nutr. 2014 Mar;99(3):535-42
references.pmid: 24401715
references.citation: Diabetologia. 2010 Apr;53(4):606-13
references.pmid: 20101384
references.citation: Ann Hepatol. 2013 Mar-Apr;12(2):256-62
references.pmid: 23396737
references.citation: Eur Rev Med Pharmacol Sci. 2011 Sep;15(9):1090-5
references.pmid: 22013734
references.citation: Proc Natl Acad Sci U S A. 2004 Nov 2;101(44):15718-23
references.pmid: 15505215
references.citation: J Clin Gastroenterol. 2008 Nov-Dec;42(10 ):1117-9
references.pmid: 18936646
references.citation: Am J Gastroenterol. 2002 Aug;97(8):2144-6
references.pmid: 12190198
references.citation: Dig Dis Sci. 2012 Feb;57(2):545-53
references.pmid: 21901256
references.citation: Mediators Inflamm. 2013;2013:986734
references.pmid: 23840101
references.citation: Clin Gastroenterol Hepatol. 2011 Jun;9(6):524-530.e1; quiz e60
references.pmid: 21440669
references.citation: Hepatology. 2012 Oct;56(4):1311-8
references.pmid: 22532269
references.citation: Best Pract Res Clin Gastroenterol. 2002 Oct;16(5):663-78
references.pmid: 12406438
references.citation: Hepatology. 2009 Jun;49(6):1877-87
references.pmid: 19291785
references.citation: J Clin Gastroenterol. 2012 Apr;46(4):272-84
references.pmid: 22395062
references.citation: Hepatology. 2013 Feb;57(2):601-9
references.pmid: 23055155
references.citation: World J Gastroenterol. 2013 Oct 28;19(40):6911-8
references.pmid: 24187469
references.citation: Hepatology. 2005 Nov;42(5):987-1000
references.pmid: 16250043
references.citation: Dig Dis Sci. 2014 Feb;59(2):238-41
references.pmid: 24385011
references.citation: Hepatology. 2012 Oct;56(4):1291-9
references.pmid: 22505276
references.citation: J Clin Gastroenterol. 2005 Jul;39(6):540-3
references.pmid: 15942443
references.citation: Hepatology. 2009 Sep;50(3):957-69
references.pmid: 19585655
references.citation: J Pediatr Gastroenterol Nutr. 2011 Jun;52(6):740-3
references.pmid: 21505361
references.citation: Nature. 2006 Dec 21;444(7122):1022-3
references.pmid: 17183309
references.citation: Gastroenterology. 2011 Oct;141(4):1249-53
references.pmid: 21726509
references.citation: J Clin Endocrinol Metab. 2002 Jul;87(7):3023-8
references.pmid: 12107194
references.citation: Am J Gastroenterol. 2011 Jan;106(1):78-80
references.pmid: 21212755
references.citation: J Gastroenterol Hepatol. 2003 Oct;18(10):1220-1
references.pmid: 12974918
references.citation: Alcohol Clin Exp Res. 2007 Jan;31(1 Suppl):S61-6
references.pmid: 17331168
references.citation: J Hepatol. 2011 May;54(5):1011-9
references.pmid: 21145828
references.citation: Cardiovasc Diabetol. 2012 Jun 07;11:61
references.pmid: 22676459
references.citation: Trends Microbiol. 2004 Dec;12(12):562-8
references.pmid: 15539116
references.citation: Diabetologia. 2005 Apr;48(4):634-42
references.pmid: 15747110
references.citation: J Nutr Biochem. 2011 Aug;22(8):699-711
references.pmid: 21292470
references.citation: Hepatology. 2012 Jun;55(6):2005-23
references.pmid: 22488764