PDF(Pubmed)
Abstract：
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver ailment worldwide, in which nonpharmacological strategies have a considerable role in the treatment. Probiotic supplementation as well as physical exercise can improve cardiometabolic parameters, but further research is needed to determine the effects of combined treatment versus exercise alone in managing NAFLD-associated biomarkers, primarily liver enzymes, lipid markers, and insulin resistance.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effects of probiotic supplementation, combined with exercise versus exercise alone, on liver enzymes and cardiometabolic markers in patients with NAFLD.
METHODS: A systematic review and meta-analysis of randomized clinical trials was performed by searching PubMed, Scopus, and Web of Science databases up to April 2024. The search was restricted to articles published in the English language and human studies. Random effects models were used to calculate weighted mean differences (WMD).
RESULTS: Pooled estimates (9 studies, 615 patients, intervention durations ranging from 8 to 48 weeks) revealed that probiotics plus exercise decreased aspartate transaminase (AST) [WMD=-5.64 U/L, p = 0.02], gamma-glutamyl transferase (GGT) [WMD=-7.09 U/L, p = 0.004], low-density lipoprotein (LDL) [WMD=-8.98 mg/dL, p = 0.03], total cholesterol (TC) [WMD=-16.97 mg/dL, p = 0.01], and homeostatic model assessment for insulin resistance (HOMA-IR) [WMD=-0.94, p = 0.005] significantly more than exercise only. However, probiotics plus exercise did not significantly change high-density lipoprotein (HDL) [WMD = 0.07 mg/dL, p = 0.9], fasting insulin [WMD=-1.47 µIU/mL, p = 0.4] or fasting blood glucose (FBG) [WMD=-1.57 mg/dL, p = 0.3] compared with exercise only. While not statistically significant, there were clinically relevant reductions in alanine aminotransferase (ALT) [WMD=-6.78 U/L, p = 0.1], triglycerides (TG) [WMD=-21.84 mg/dL, p = 0.1], and body weight (BW) [WMD=-1.45 kg, p = 0.5] for probiotics plus exercise compared with exercise only. The included studies exhibited significant heterogeneity for AST (I2 = 78.99%, p = 0.001), GGT (I2 = 73.87%, p = 0.004), LDL (I2 = 62.78%, p = 0.02), TC (I2 = 72.41%, p = 0.003), HOMA-IR (I2 = 93.86%, p = 0.001), HDL (I2 = 0.00%, p = 0.9), FBG (I2 = 66.30%, p = 0.01), ALT (I2 = 88.08%, p = 0.001), and TG (I2 = 85.46%, p = 0.001). There was no significant heterogeneity among the included studies for BW (I2 = 0.00%, p = 0.9).
CONCLUSIONS: Probiotic supplementation combined with exercise training elicited better results compared to exercise alone on liver enzymes, lipid profile, and insulin resistance in patients with NAFLD.
BACKGROUND: PROSPERO registration number CRD42023424290.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effects of probiotic supplementation, combined with exercise versus exercise alone, on liver enzymes and cardiometabolic markers in patients with NAFLD.
METHODS: A systematic review and meta-analysis of randomized clinical trials was performed by searching PubMed, Scopus, and Web of Science databases up to April 2024. The search was restricted to articles published in the English language and human studies. Random effects models were used to calculate weighted mean differences (WMD).
RESULTS: Pooled estimates (9 studies, 615 patients, intervention durations ranging from 8 to 48 weeks) revealed that probiotics plus exercise decreased aspartate transaminase (AST) [WMD=-5.64 U/L, p = 0.02], gamma-glutamyl transferase (GGT) [WMD=-7.09 U/L, p = 0.004], low-density lipoprotein (LDL) [WMD=-8.98 mg/dL, p = 0.03], total cholesterol (TC) [WMD=-16.97 mg/dL, p = 0.01], and homeostatic model assessment for insulin resistance (HOMA-IR) [WMD=-0.94, p = 0.005] significantly more than exercise only. However, probiotics plus exercise did not significantly change high-density lipoprotein (HDL) [WMD = 0.07 mg/dL, p = 0.9], fasting insulin [WMD=-1.47 µIU/mL, p = 0.4] or fasting blood glucose (FBG) [WMD=-1.57 mg/dL, p = 0.3] compared with exercise only. While not statistically significant, there were clinically relevant reductions in alanine aminotransferase (ALT) [WMD=-6.78 U/L, p = 0.1], triglycerides (TG) [WMD=-21.84 mg/dL, p = 0.1], and body weight (BW) [WMD=-1.45 kg, p = 0.5] for probiotics plus exercise compared with exercise only. The included studies exhibited significant heterogeneity for AST (I2 = 78.99%, p = 0.001), GGT (I2 = 73.87%, p = 0.004), LDL (I2 = 62.78%, p = 0.02), TC (I2 = 72.41%, p = 0.003), HOMA-IR (I2 = 93.86%, p = 0.001), HDL (I2 = 0.00%, p = 0.9), FBG (I2 = 66.30%, p = 0.01), ALT (I2 = 88.08%, p = 0.001), and TG (I2 = 85.46%, p = 0.001). There was no significant heterogeneity among the included studies for BW (I2 = 0.00%, p = 0.9).
CONCLUSIONS: Probiotic supplementation combined with exercise training elicited better results compared to exercise alone on liver enzymes, lipid profile, and insulin resistance in patients with NAFLD.
BACKGROUND: PROSPERO registration number CRD42023424290.
摘要：
背景：非酒精性脂肪性肝病（NAFLD）是世界上最常见的慢性肝病，其中非药物策略在治疗中具有相当大的作用。益生菌补充剂以及体育锻炼可以改善心脏代谢参数，但需要进一步的研究来确定联合治疗与单独运动在管理NAFLD相关生物标志物方面的效果，主要是肝酶，脂质标记，和胰岛素抵抗。
目的：本系统综述和荟萃分析旨在评估益生菌补充剂的效果，结合运动与单独运动，NAFLD患者的肝酶和心脏代谢标志物。
方法：通过检索PubMed,Scopus,和截至2024年4月的WebofScience数据库。搜索仅限于以英语和人类研究发表的文章。随机效应模型用于计算加权平均差(WMD)。
结果：汇总估计(9项研究，615名患者，干预持续时间从8到48周不等）显示益生菌加运动可降低天冬氨酸转氨酶（AST）[WMD=-5.64U/L，p=0.02],γ-谷氨酰转移酶（GGT）[WMD=-7.09U/L，p=0.004],低密度脂蛋白（LDL）[WMD=-8.98mg/dL，p=0.03],总胆固醇（TC）[WMD=-16.97mg/dL，p=0.01],胰岛素抵抗的稳态模型评估（HOMA-IR）[WMD=-0.94，p=0.005]显着高于仅运动。然而,益生菌加运动并没有显着改变高密度脂蛋白（HDL）[WMD=0.07mg/dL，p=0.9],空腹胰岛素[WMD=-1.47µIU/mL，p=0.4]或空腹血糖（FBG）[WMD=-1.57mg/dL，p=0.3]与仅运动相比。虽然没有统计学意义，丙氨酸转氨酶（ALT）[WMD=-6.78U/L，p=0.1],甘油三酯（TG）[WMD=-21.84mg/dL，p=0.1],和体重(BW)[WMD=-1.45公斤，与仅运动相比，益生菌加运动的p=0.5]。纳入的研究对AST表现出显著的异质性(I2=78.99%，p=0.001),GGT(I2=73.87%,p=0.004),LDL（I2=62.78%，p=0.02),TC(I2=72.41%，p=0.003),HOMA-IR（I2=93.86%，p=0.001),HDL(I2=0.00%,p=0.9),FBG(I2=66.30%,p=0.01),ALT(I2=88.08%,p=0.001),和TG(I2=85.46%，p=0.001)。纳入的BW研究之间没有显著的异质性(I2=0.00%，p=0.9)。
结论：与单独运动相比，益生菌补充剂联合运动训练对肝酶的影响更好，血脂谱,NAFLD患者的胰岛素抵抗。
背景：PROSPERO注册号CRD42023424290。
目的：本系统综述和荟萃分析旨在评估益生菌补充剂的效果，结合运动与单独运动，NAFLD患者的肝酶和心脏代谢标志物。
方法：通过检索PubMed,Scopus,和截至2024年4月的WebofScience数据库。搜索仅限于以英语和人类研究发表的文章。随机效应模型用于计算加权平均差(WMD)。
结果：汇总估计(9项研究，615名患者，干预持续时间从8到48周不等）显示益生菌加运动可降低天冬氨酸转氨酶（AST）[WMD=-5.64U/L，p=0.02],γ-谷氨酰转移酶（GGT）[WMD=-7.09U/L，p=0.004],低密度脂蛋白（LDL）[WMD=-8.98mg/dL，p=0.03],总胆固醇（TC）[WMD=-16.97mg/dL，p=0.01],胰岛素抵抗的稳态模型评估（HOMA-IR）[WMD=-0.94，p=0.005]显着高于仅运动。然而,益生菌加运动并没有显着改变高密度脂蛋白（HDL）[WMD=0.07mg/dL，p=0.9],空腹胰岛素[WMD=-1.47µIU/mL，p=0.4]或空腹血糖（FBG）[WMD=-1.57mg/dL，p=0.3]与仅运动相比。虽然没有统计学意义，丙氨酸转氨酶（ALT）[WMD=-6.78U/L，p=0.1],甘油三酯（TG）[WMD=-21.84mg/dL，p=0.1],和体重(BW)[WMD=-1.45公斤，与仅运动相比，益生菌加运动的p=0.5]。纳入的研究对AST表现出显著的异质性(I2=78.99%，p=0.001),GGT(I2=73.87%,p=0.004),LDL（I2=62.78%，p=0.02),TC(I2=72.41%，p=0.003),HOMA-IR（I2=93.86%，p=0.001),HDL(I2=0.00%,p=0.9),FBG(I2=66.30%,p=0.01),ALT(I2=88.08%,p=0.001),和TG(I2=85.46%，p=0.001)。纳入的BW研究之间没有显著的异质性(I2=0.00%，p=0.9)。
结论：与单独运动相比，益生菌补充剂联合运动训练对肝酶的影响更好，血脂谱,NAFLD患者的胰岛素抵抗。
背景：PROSPERO注册号CRD42023424290。
