Short-term synbiotic supplementation and intrahepatic triglyceride content assessed by proton MR spectroscopy: a pilot study

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic dysfunction-associated steatotic liver disease (MASLD), is strongly linked to obesity, insulin resistance, and metabolic syndrome. Alterations in gut microbiota have been implicated in its pathogenesis, and synbiotic therapies combining probiotics and prebiotics have gained interest as potential treatment strategies. OBJECTIVE: To investigate the effects of 3-month synbiotic supplementation on intrahepatic triglyceride (IHTG) content as the primary outcome, along with biochemical parameters, in patients with NAFLD, assessed by proton magnetic resonance spectroscopy (¹H-MRS). METHODS: Nineteen patients diagnosed with NAFLD based on ultrasonography or biopsy were recruited; after exclusions, 18 patients completed the study. All participants received a daily synbiotic capsule containing Lactobacillus acidophilus (LA-5), Bifidobacterium animalis subsp. lactis (BB-12), and prebiotics (inulin, oligofructose, potato starch) for 12 weeks. IHTG was quantified by ¹H-MRS before and after treatment. Routine biochemical and hematological parameters were also evaluated. RESULTS: After 12 weeks, IHTG content decreased significantly (13.02 ± 6.74% vs. 9.34 ± 4.44%, p = 0.021). Serum ALT (p = 0.023), AST (p = 0.013), and LDL cholesterol (p = 0.032) levels decreased significantly, while platelet count increased (p = 0.009). Fibrosis-4 Index (FIB-4) values also showed a significant reduction following treatment (p = 0.002). Body weight and BMI demonstrated a trend toward reduction without reaching statistical significance. Other biochemical parameters remained unchanged. Logistic regression analysis identified baseline triglyceride levels as the strongest predictor of steatosis progression despite therapy. CONCLUSION: Short-term synbiotic supplementation significantly reduced hepatic steatosis and improved selected biochemical parameters in MASLD patients. These findings support the potential role of microbiota-targeted therapies as adjunctive treatment in NAFLD/MASLD. Larger randomized controlled trials are warranted.