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Background and objective: There is evidence suggesting a relationship between synbiotics and nonalcoholic fatty liver disease (NAFLD). Also, probable associations of synbiotics with liver and inflammatory responses are presently being investigated. The aim of our study was to determine the effects of supplementation of diet with synbiotics on the liver enzymes, inflammatory markers and hepatic fibrosis in patients with NAFLD. Materials and methods: In this double-blind randomized clinical trial, 52 patients with NAFLD were divided in two groups, one (experimental group ) receiving daily 2 synbiotic capsules (each one containing 7 probiotic strains and fructooligosaccharides) and the other (control group) receiving 2 placebo capsules, for 28 weeks. Both groups were advised to follow an energy-balanced diet and recommended to perform physical activity. Liver enzymes, inflammatory markers and hepatic fibrosis were assessed at baseline and the end of the study. In addition, at weeks 0, 14 and 28 data were collected on anthropometric measurements and physical activity. The STATA11 software was used for data analysis. Results: At baseline no significant differences were seen in the background variables between the two groups. After 28 weeks, liver enzymes, inflammatory markers and hepatic fibrosis in the synbiotic group decreased significantly as compared with the placebo group (P<0.001). Moreover, the treatment brought about a reduction of 2.99 kPa in the hepatic fibrosis score (P<0.001) in the experimental group. Conclusion: On the basis of the findings it can be concluded that synbiotic supplementation can bring about improvements in liver enzymes and inflammatory markers and affect favorably liver fibrosis in patients with NAFLD. Keywords: NAFLD, Synbiotic, Inflammatory markers

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Background and Objectives: There is evidence suggesting a relationship between flaxseed and NAFLD risk factor management including obesity, insulin resistance and diabetes. The objective of present study was to evaluate the effects of supplementation with Flaxseed on liver enzymes, hepatic fibrosis and steatosis in patients with NAFLD.

Materials and Methods: A two-arm randomized controlled clinical trial was conducted on 50 patients with NAFLD. The participants were assigned into a lifestyle modification (LM) on the NIH guidelines, or LM + 30 g/d brown milled Flaxseed for 12 weeks. Liver enzymes and hepatic fibrosis and steatosis were assessed at the baseline and at the end of the study. In addition, data were collected on anthropometric measurements and physical activity. The SPSS 20^th version was used for data analysis.

Results: Among the 50 volunteers, 24 in the treatment group and 22 in the control group completed the study. At the baseline, no significant differences were seen in the background variables between the two groups. After 12 weeks, flaxseed supplementation was associated with a significantly greater reduction in the liver enzymes of alanin aminotransferase, aspartate aminotransferase and &gamma-glutamyltransferas (P < 0.05). The mean reduction in fibrosis score in the flaxseed group was significantly greater than in the control group (-1.26 vs. -0.78 P = 0.03), similarly as steatosis score (-47 vs. -15.47 P = 0.04).

Conclusion: On the basis of the findings, it can be concluded that flaxseed supplementation can act as a new therapeutic approach in NAFLD management.

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Background and Objectives: High prevalence of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus results in deleterious complications and morbidities. Therefore, the aim of this study was to assess nutritional and anthropometrical risk factors in progression of non-alcoholic fatty liver disease in diabetic patients.
 Materials & Methods: Totally, 133 non-alcoholic fatty liver disease patients (CAP score > 270) and 67 controls (CAP score < 270) were selected from the patients with type 2 diabetes mellitus in a clinic. Dietary phytochemical index was calculated via data from a validated 147-item FFQ. Body composition were measured using dual-energy X-ray absorptiometry. Other anthropometric indices and laboratory assays were used as well. Logistic regression models were used to estimate multivariable ORs.
Results: After adjustment for potential confounders, risk of progression for non-alcoholic fatty liver disease in participants with higher dietary phytochemical indices significantly decreased (OR = 0.35, 95% CI: 0.12–0.98, p = 0.048). After fully adjustment of covariates and independently from body mass index, positive associations were seen between the highest tertile of TLR (OR = 7.99, 95% CI: 2.43–26.26, p = 0.001), METS-VF (OR = 4.55, 95% CI: 1.46–14.2,
 p = 0.009) and risk of non-alcoholic fatty liver disease.
Conclusion: Findings of this study have demonstrated that phytochemical components of diet play protective roles against non-alcoholic fatty liver disease.  Moreover, TLR and METS-VF are addressed as novel estimators of central obesity as a risk factor for non-alcoholic fatty liver disease in diabetes.
 

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Background and Purpose: Nonalcoholic fatty liver disease is known as a chronic liver disease, whose prevalence is increasing worldwide and if not treated can lead to hepatic cirrhosis and fibrosis. The gold standard for diagnosing non-alcoholic fatty liver disease and assessing the extent of liver fibrosis is liver biopsy; however, this is an invasive method that can lead to possible side effects. Therefore, use of non-invasive methods is suggested. The aim of this study was to assess effects of intermittent fasting and flaxseed consumption on liver fibrosis through non-invasive marker panel and Fibroscan in patients with non-alcoholic fatty liver disease.
Methods and Materials: Changes in liver fibrosis in fifty patients with non-alcoholic fatty liver disease were investigated using intermittent fasting diet with daily consumption of 30 g of flaxseed supplement in a randomized clinical trial. At the beginning and at the end of the study, height and weight of the participants were measured. Body mass index, physical activity questionnaire (physical activity using the international physical activity questionnaire) and 24-h recall were completed by the patients at the beginning and the end of the study. Approximate duration of the study was 12 w. Hepatic fibrosis assessment methods that used at the beginning and the end of the study included Fibroscan and calculation of non-invasive marker panel, such as fibrosis 4 (FIB-4), AST aminotransferase platelet ratio index (APRI) and body mass index, AST/ALT aminotransferase ratio, Diabetes (BARD).
Results: In general, 45 patients with nonalcoholic fatty liver disease with an average age of 46.83 years old and an average BMI of 32.79 kg/m² were included in the analysis. Results of this study showed that following diets with supplements, hepatic fibrosis score decreased using Fibroscan assay (p = 0.507), BARD (p = 0.396), FIB-4 (p = 0.984) and APRI
(p = 0.682); however, none of them were statistically significant after 12 w, compared to the control group.
Conclusion: Results of Fibroscan and BARD, FIB-4 and APRI indices were similar in assessing liver fibrosis changes after the intervention. Future studies with larger sample sizes are needed to verify these results.

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Background and Objectives: Non-alcoholic fatty liver disease is closely associated with metabolic disorders such as obesity and type 2 diabetes. This study investigated the relationship between ultra-processed food consumption and development of non-alcoholic fatty liver disease in individuals with type 2 diabetes.
Materials and Methods: In this cross-sectional study, 200 individuals with type 2 diabetes were included; of which, 133 had non-alcoholic fatty liver disease and 67 did not, based on Fibroscan results. Dietary intake was assessed using food frequency questionnaire and processed food consumption was estimated using NOVA classification system. Demographic and clinical data were collected as well. Logistic regression models were used to assess the association between ultra-processed food intake and the risk of developing non-alcoholic fatty liver disease.
Results: Body mass index was significantly higher in people with non-alcoholic fatty liver disease (p < 0.001). Although no significant differences were seen in total calorie intake between the groups, individuals with non-alcoholic fatty liver disease had significantly higher consumptions of ultra-processed (NOVA 4) (p = 0.006) and processed foods (NOVA 3) (p = 0.032). Logistic regression analysis indicated that higher ultra-processed food intake was significantly associated to an increased risk of non-alcoholic fatty liver disease in individuals with type 2 diabetes. After adjusting for all confounding factors, the risk of non-alcoholic fatty liver disease in individuals in the highest tertile of ultra-processed food intake was more than 3 times higher than those in the first tertile of ultra-processed food intake (OR = 3.23, 95% CI: 1.27, 8.22, p = 0.019).
Conclusion: This study has detected that consumption of ultra-processed foods is associated to an increased risk of non-alcoholic fatty liver disease in individuals with type 2 diabetes, indicating the importance of diet managing in liver health.