title: The Effect of Symbiotic Supplementation on Liver Enzymes, C-reactive Protein and Ultrasound Findings in Patients with Non-alcoholic Fatty Liver Disease: A Clinical Trial.
abstract: BACKGROUND
  Regarding to the growing prevalence of nonalcoholic fatty liver disease (NAFLD), concentrating on various strategies to its prevention and management seems necessary. The aim of this study was to determine the effects of symbiotic on C-reactive protein (CRP), liver enzymes, and ultrasound findings in patients with NAFLD.
  
  
  METHODS
  Eighty NAFLD patients were enrolled in this randomized, double-blind, placebo-controlled clinical trial. Participants received symbiotic in form of a 500 mg capsule (containing seven species of probiotic bacteria and fructooligosaccharides) or a placebo capsule daily for 8 weeks. Ultrasound grading, CRP, and liver enzymes were evaluated at the baseline and the end of the study.
  
  
  RESULTS
  In the symbiotic group, ultrasound grade decreased significantly compared to baseline (P < 0.005) but symbiotic supplementation was not associated with changes in alanine aminotransferase (ALT) and aspartate transaminase (AST) levels. In the placebo group, there was no significant change in steatosis grade whereas ALT and AST levels were significantly increased (P = 0.002, P = 0.02, respectively). CRP values remained static in either group.
  
  
  CONCLUSIONS
  Symbiotic supplementation improved steatosis in NAFLD patients and might be useful in the management of NAFLD or protective against its progression.
authors.affiliation: Department of Community Nutrition, Food Security Research Centre, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Treatment Affair, Shahrekord University of Medical Sciences, Shahrekord, Iran.
authors.forename: Atefe
authors.initials: A
authors.lastname: Asgharian
authors.affiliation: Department of Community Nutrition, Food Security Research Centre, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Askari
authors.affiliation: Department of Community Nutrition, Food Security Research Centre, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Esmailzade
authors.affiliation: Department of Community Nutrition, Food Security Research Centre, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Awat
authors.initials: A
authors.lastname: Feizi
authors.affiliation: Department of Community Nutrition, Food Security Research Centre, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Vida
authors.initials: V
authors.lastname: Mohammadi
keywords: Liver steatosis; nonalcoholic fatty liver disease; symbiotic