Key points:  Results from a recent study showed that 12 weeks of supplementation with probiotics significantly lowered cholesterol, triglycerides, and waist circumference in pediatric patients diagnosed with nonalcoholic fatty liver disease (NAFLD).

NAFLD is the buildup of excess fat in the liver, not associated with alcohol consumption, which affects enzymatic and metabolic processes. The percentage of obese individuals that develop NAFLD is on the rise across all age groups including children. The overall prevalence of NAFLD in the pediatric population is approximately 10% and as high as 40-70% among obese children, making this the most common chronic liver disease in children.1 There are currently no prescriptive treatments available to children with NAFLD and lifestyle interventions often have poor compliance rates.

Numerous studies have demonstrated the impact of the human gut microbiome on weight gain and liver activity. Although the mechanisms are not yet well understood, it is believed that gut bacteria also have a significant influence on NAFLD and may play a role in reversing or slowing the progression of this process.

A recent study led by Dr. Fatemeh Famouri was published in the Journal of Pediatric Gastroenterology and Nutrition in March 2017.  This study was designed to determine if oral probiotics could address some of the symptoms and long-term health effects of NAFLD in children. Sixty-four obese children with NAFLD, diagnosed by sonogram, were enrolled in a randomized control trial and were assigned to either a probiotic or placebo group.

The subjects in the probiotic group received one capsule daily of a probiotic combination of Lactobacillus acidophilus, 3 × 10 colony forming units (CFU); Bifidobacterium lactis, 6 × 10 CFU; Bifidobacterium bifidum, 2 × 10 CFU; and Lactobacillus rhamnosus, 2 × 10 CFU. The trial lasted twelve weeks and measured alanine and aspartate aminotransferase activity, total cholesterol, low-density lipoprotein C, triglyceride levels, waist circumference, and body-mass index.  Sonograms were taken post-intervention for comparison.

After the 12 week intervention, results showed a significant decrease in aspartate and alanine aminotransferase activity in the probiotic group as compared to the placebo group indicating a reduction in hepatocyte destruction, improved liver function and reduction of fatty liver size.  Cholesterol levels, low density lipoprotein C, triglyceride levels and waist circumference also decreased in the intervention group.  Weight, body mass index and body mass z-scores did not change. At the end of the study seventeen participants in the probiotic group had normal sonograms as did 5 in the placebo group.

While this was a small clinical trial, the results show that a 12-week course of the chosen probiotic combination had a positive impact on sonographic fatty liver results in a pediatric population. The intervention also had positive effects on lowering cholesterol, low-density lipoprotein C, triglycerides, and waist circumference while supporting healthy liver enzyme levels.

Why is this clinically relevant?

  • Supplementation with specific probiotic combinations in pediatric patients with NAFLD may improve lipid profiles and waist circumference in this patient population
  • In this 12 week study, probiotics improved alanine and aspartate aminotransferase activity in pediatric NAFLD patients indicating improved liver function and reduction in fatty liver size


[1] “Pediatric non-alcoholic fatty liver disease: Recent solutions, unresolved issues, and future research directions”

Link to abstract


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