The Potential Role of Probiotics or/and Prebiotic on Serum Lipid Profile and Insulin Resistance in Alcoholic Fatty Liver Disease: A Double Blind Randomized Clinical Trial

Objective: Nonalcoholic fatty liver disease (NAFLD) is a chronic disease linked to insulin resistance and fatty acid synthesis. Insulin resistance plays an important role in the pathogenesis of NAFLD causing multiple lipid metabolism disorders. Supplementing probiotics and prebiotics is a complementary therapy in obesity-related disorders, including dyslipidemia and insulin resistance. The objective of this study was to evaluate the effect of probiotic and prebiotic supplementation on serum lipid profile and insulin resistance in patients with NAFLD. Materials and Methods: In this study, 84 subjects were divided into 4 groups. The first group received probiotic capsules (B.L and L.A: 2*107 CFU/d) and placebo of prebiotic (maltodextrin powder), the second group received prebiotic as sachet (inulin HP: 10 g/d) and placebo of probiotic (fat- and lactose-free milk capsules), the third group received probiotic and prebiotic, and the fourth group received a placebo of probiotic and prebiotic, for 3 months. Anthropometric characteristics, insulin resistance biomarkers and lipid profile were measured for all patients before and after the intervention. The primary outcome of the study was the Homeostasis model of assessment insulin resistance (HOMA-IR) level. The remaining variables (i.e., glucose, insulin, TC, TG, HDL, LDL, weight and BMI changes) were considered represent secondary outcomes. Results: Results showed that probiotic consumption was able to decrease BMI and weight in all the intervention groups in comparison to the placebo group. The serum levels of HDL and LDL differed significantly in the probiotic and pro- and prebiotic groups in comparison to the placebo group. In addition, there were no statistically significant reduction in TC, glucose, insulin levels and HOMA-IR in the intervention groups in comparison to the placebo group. Based on the analysis of covariance (ANCOVA) test, there were significant differences in HDL (P = 0.005) and LDL (P = 0.028) serum levels between the groups at the end of the study. Conclusion: Probiotic and prebiotic supplementation may be effective in improving serum lipid profile and insulin resistance markers in patients diagnosed with NAFLD.