Probiotics as a therapeutic strategy for metabolic dysfunction-associated steatotic liver disease: A systematic review and meta-analysis.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is recognized as one of the most common chronic liver conditions globally, presenting a significant public health. Probiotics, as modulators of intestinal microbiota, have emerged attention as a potential therapeutic strategy for managing MASLD. This systematic review and meta-analysis encompassed 12 randomized controlled trials including 657 participants to quantify the effects of probiotic supplementation on liver function indicators, lipid metabolism, and inflammatory markers in MASLD patients. Compared with placebo, probiotics significantly reduced liver-related measures, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transaminase (GGT) levels (MD: 8.12 IU/L, MD: 7.98 IU/L, MD: 6.43IU/L). Meanwhile, probiotics also demonstrated significantly reduction in triglyceride (TG) and total cholesterol (TC) levels (MD: 9.35 mg/dL, MD: 7.91 mg/dL). Furthermore, probiotics significantly increased high-density lipoprotein cholesterol (HDL-C) levels (MD: 3.31 mg/dL) and decreased low-density lipoprotein cholesterol (LDL-C) levels (MD: 6.31 mg/dL). Given the substantial heterogeneity observed in certain indicators (ALT, AST, TG, HDL-C), a subgroup analysis was conducted. Subgroup analysis revealed that these improvements were more pronounced in adults, though heterogeneity was higher compared to children, indicating more consistent effects in pediatric populations. This study further confirmed the potential value of probiotics in improving liver function and lipid metabolism in patients with MASLD by a rigorous meta-analysis that excluded the influence of potential interfering factors, such as regional factors and publication time. This study provides a better understanding of the individual differences in the effects of probiotic treatment and a solid theoretical basis for the development of relevant intervention products.