More on Current Evidences on Probiotics as a Novel Treatment for Non-Alcoholic Fatty Liver Disease

In their recent article Kelishadi et al. (1) analyzed in a clear and concise way a number of key aspects of obesity-related NAFLD, deepening in particular the role of gut microflora and its potential therapeutic modulation by probiotics. From their paper it is apparent that most promises still derive from a relevant number of studies conducted in different NAFLD animal models. When interpreting data obtained in these models one should however remind that other factors like physical activity, social and chemical environment, psychological stress factors and genetics are also important contributors to the development of human NAFLD and to its incredible resistance to treatments as well (2). In this respect Dr. Kelishadi and col-leagues' review of four available clinical trials on human population is therefore particularly welcomed. In three studies probiotic treatments appear to improve somehow NAFLD related parameters. The fourth study, published in 2008 by doctor Diehl's group, instead warned versus probiotics treatment of NAFLD, reporting that ste-atosis measured by proton magnetic resonance spectros-copy increased in three out of four patients treated with VSL#3 for 4 months (3). In addition to these meagre evidences, in recent times, Malguarnera et al. showed in histologically monitored NAFLD patients that Bifidobacterium longum + fructo-oligosaccharides (FOS) treatment and lifestyle modification , when compared to lifestyle modification alone, significantly reduced a number of serum inflammatory, metabolic, toxinic and cytolitic parameters, along with improved histological steatosis, and NASH activity index (4). Even more recently, a further open label random-ized controlled trial in 20 obese adult patients with biopsy proven NAFLD appeared fairly promising. Patients received a six month formula containing five strains of bacteria (4 lactobacilli + Bifidobacterium bifidum) + FOS. Treatment resulted in reduction of liver fat (P = 0.034) and AST level (absolute change P = 0.021; percentage of baseline value P = 0.008) (5). In all cases, it should be emphasized that the hitherto available study designs are not homogeneous and data results cannot be easily compared. Study population of two examined series by dr Kelishadi and colleagues for example included different chronic liver diseases in addition to NAFLD (6, 7); probiotics preparations often contained different bacteria strains, and sometimes confounding prebiotics (FOS) and/or vitamins cocktails (4-6); study duration was quite different, and it is still not clear if longer study may be affected by a number of biases like concurrent unpredictable major life style modifications, and at which extent. Last, but …