Results of a new trial demonstrated that the combination of probiotics and omega-3 fatty acids reduced the risk for steatosis (fatty liver) in patients with nonalcoholic fatty liver disease (NAFLD).
Previous research has shown that modulation of the gut microbiota via probiotics supplementation may have beneficial effects on the gut-liver axis and metabolic and immunologic responses, and omega-3 supplementation may improve liver lipid metabolism and adipose tissue function [2, 3]. Seeing the potential, researchers from the Bogomolets National Medical University (Kiev, Ukraine) investigated the effects of the combination of probiotics and omega-3 fatty acids in an animal model of NAFLD. They found that the combination had a more pronounced reduction in hepatic steatosis and hepatic lipid accumulation than the probiotics alone.
Subsequently, they tested the efficacy of the combination in a clinical setting that included 48 adults with NAFLD. Twenty-six participants were randomized to receive the combination of a multi-strain probiotic supplement and an omega-3 supplement containing flax and wheat germ oil, and 22 were randomized to receive placebo. The treatment duration was 8 weeks.
In the treatment group, the Fatty Liver Index scores decreased from 83.5 at baseline to 76.3 at 8 weeks (p<0.001). In the placebo group, the Fatty Liver Index scores remained unaffected. The researchers also noticed significant improvements in multiple inflammatory markers (such as TNF-α, IL-1β, IL-6, IL-8 and IFN-γ) in some participants in the treatment group but not in anyone in the placebo group.
These data indicate potential benefits of probiotics and omega-3 fatty acids in the management of NAFLD. However, the current study has a very small sample size, a short intervention period, and a lack of long-term follow-up. A larger long-term trial is necessary to determine whether this combination leads to clinically meaningful outcomes.
The study results were presented at the United European Gastroenterology (UEG) Week 2017 in Barcelona, Spain (November 2017).
Why is this Clinically Relevant?
- NAFLD is one of the most common liver diseases worldwide with nearly 1 in 3 adults in the U.S. being diagnosed with it
- The prevalence of NAFLD is even higher in adults with obesity, diabetes and hyperlipidemia 
- Nutrition and lifestyle modification is essential for the management of NAFLD, clinicians may consider incorporating probiotics and omega-3 fatty acids supplements as a part of a lifestyle program
 Kobyliak, N., et al. Co-administration of probiotic with omega-3 fatty acids in NAFLD management: evidence from animals to randomized clinical studies. in United European Gastroenterology Week 2017. 2017. Barcelona, Spain.
 Kobyliak, N., et al., Probiotics Supplemented with Omega-3 Fatty Acids are More Effective for Hepatic Steatosis Reduction in an Animal Model of Obesity. Probiotics Antimicrob Proteins, 2017. 9(2): p. 123-130.
 Eslamparast, T., et al., Probiotics and Nonalcoholic Fatty liver Disease. Middle East J Dig Dis, 2013. 5(3): p. 129-36.
 Le, M.H., et al., Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States. PLoS One, 2017. 12(3): p. e0173499.