Treatment of Nonalcoholic Fatty Liver Disease With Probiotics and Prebiotics

Inclusion Criteria: * Age 18 to 70 years * Fatty liver identified by imaging studies including ultrasound, computer tomography or magnetic resonance imaging * Elevated alanine aminotransferase (ALT) according to Prati's criteria (\>30 IU/l in men and \>19 IU/l in women)18 * Written informed consent obtained Exclusion Criteria: * Positive hepatitis B surface antigen, anti-hepatitis C virus antibody, or anti-nuclear antibody titer above 1/160 * Alcohol consumption above 30 g per week in men or 20 g per week in women * ALT above 10 times the upper limit of normal * Liver decompensation, as evidenced by bilirubin above 50 µmol/l, platelet count below 100 × 109/l, prothrombin time above 1.3 times the upper limit of normal, albumin below 35 g/l, presence of ascites or varices * Use of systemic corticosteroids and methotrexate in the last 6 months * Evidence of hepatocellular carcinoma * Terminal illness or cancer, unless in complete remission for more than 5 years