The Role of Probiotics in Managing Metabolic-Associated Fatty Liver Disease: An Updated Review

Metabolic-associated fatty liver disease (MAFLD) has become a very significant health problem worldwide, characterized by hepatic steatosis and systemic metabolic disturbances. Grasping the complex interaction between the intestine and liver, referred to as the gut-liver axis, is crucial to decipher the pathogenesis of MAFLD and identify potential therapeutic targets. Probiotics, which are live microorganisms offering health benefits, have garnered attention for their potential in treating MAFLD. A literature search in PubMed and Google Scholar using "MAFLD," "NAFLD," "probiotics," and "gut microbiota" yielded 642 studies; 32 clinical trials met the inclusion criteria for the final analysis. This review encapsulates the current knowledge of MAFLD pathophysiology, emphasizing the role of the gut-liver axis, and assesses the clinical evidence supporting probiotic treatments for MAFLD. The mechanisms of action of probiotics are explored, including their ability to modulate gut microbiota composition, enhance epithelial barrier function, and influence the immune response. Various randomized controlled trials have shown that probiotics are effective in enhancing several aspects of MAFLD, such as liver enzymes, lipid profiles, body mass index, insulin sensitivity, or even histological efficacy. However, mixed results have been reported in some clinical trials, highlighting the need for further research to optimize probiotic interventions. Future investigations should focus on standardized protocols, personalized approaches and exploring synergistic combinations with other therapeutic modalities to maximize the potential of probiotics in the treatment of MAFLD.