Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD)
<i>Background</i>: Non-alcoholic fatty liver disease (NAFLD) can be ameliorated by weight loss although difficult to maintain. Emerging evidence indicates that prebiotics and antibiotics improve NAFLD. <i>Aim</i>: To determine whether inulin supplementation after brief metron...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-03-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/12/4/937 |
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| author | Clara Yieh Lin Chong David Orr Lindsay D. Plank Tommi Vatanen Justin M. O'Sullivan Rinki Murphy |
| author_facet | Clara Yieh Lin Chong David Orr Lindsay D. Plank Tommi Vatanen Justin M. O'Sullivan Rinki Murphy |
| author_sort | Clara Yieh Lin Chong |
| collection | DOAJ |
| description | <i>Background</i>: Non-alcoholic fatty liver disease (NAFLD) can be ameliorated by weight loss although difficult to maintain. Emerging evidence indicates that prebiotics and antibiotics improve NAFLD. <i>Aim</i>: To determine whether inulin supplementation after brief metronidazole therapy is effective in reducing alanine aminotransferase (ALT) and maintaining weight loss achieved through a very-low-calorie diet (VLCD) among people with NAFLD. <i>Methods</i>: Sixty-two people with NAFLD commenced 4-week VLCD using Optifast meal replacements (600 kcal/day). Sixty were then randomised into a 12-week double-blind, placebo-controlled, parallel three-arm trial: (1) 400 mg metronidazole twice daily in Week 1 then inulin 4 g twice daily OR (2) placebo twice daily in week one then inulin OR (3) placebo-placebo. Main outcomes were ALT and body weight at 12 weeks. Fecal microbiota changes were also evaluated. <i>Results</i>: Mean body mass index (BMI) and ALT reduced after VLCD by 2.4 kg/m<sup>2</sup> and 11 U/L, respectively. ALT further decreased after metronidazole-inulin compared to after placebo-placebo (mean ALT change −19.6 vs. −0.2 U/L, respectively; <i>p</i> = 0.026); however, weight loss maintenance did not differ. VLCD treatment decreased the ratio of <i>Firmicutes</i>/<i>Bacteroidetes</i> (<i>p</i> = 0.002). <i>Conclusion</i>: Brief metronidazole followed by inulin supplementation can reduce ALT beyond that achieved after VLCD in patients with NAFLD. |
| first_indexed | 2024-03-11T10:10:53Z |
| format | Article |
| id | doaj.art-6d54ceb9e9854b5ba53d4aa3537aed70 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-11T10:10:53Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-6d54ceb9e9854b5ba53d4aa3537aed702023-11-16T14:30:50ZengMDPI AGNutrients2072-66432020-03-0112493710.3390/nu12040937Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD)Clara Yieh Lin Chong0David Orr1Lindsay D. Plank2Tommi Vatanen3Justin M. O'Sullivan4Rinki Murphy5Liggins Institute, The University of Auckland, Auckland 1142, New ZealandNew Zealand Liver Transplant Unit, Auckland City Hospital, Auckland 1023, New ZealandDepartment of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New ZealandLiggins Institute, The University of Auckland, Auckland 1142, New ZealandLiggins Institute, The University of Auckland, Auckland 1142, New ZealandDepartment of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand<i>Background</i>: Non-alcoholic fatty liver disease (NAFLD) can be ameliorated by weight loss although difficult to maintain. Emerging evidence indicates that prebiotics and antibiotics improve NAFLD. <i>Aim</i>: To determine whether inulin supplementation after brief metronidazole therapy is effective in reducing alanine aminotransferase (ALT) and maintaining weight loss achieved through a very-low-calorie diet (VLCD) among people with NAFLD. <i>Methods</i>: Sixty-two people with NAFLD commenced 4-week VLCD using Optifast meal replacements (600 kcal/day). Sixty were then randomised into a 12-week double-blind, placebo-controlled, parallel three-arm trial: (1) 400 mg metronidazole twice daily in Week 1 then inulin 4 g twice daily OR (2) placebo twice daily in week one then inulin OR (3) placebo-placebo. Main outcomes were ALT and body weight at 12 weeks. Fecal microbiota changes were also evaluated. <i>Results</i>: Mean body mass index (BMI) and ALT reduced after VLCD by 2.4 kg/m<sup>2</sup> and 11 U/L, respectively. ALT further decreased after metronidazole-inulin compared to after placebo-placebo (mean ALT change −19.6 vs. −0.2 U/L, respectively; <i>p</i> = 0.026); however, weight loss maintenance did not differ. VLCD treatment decreased the ratio of <i>Firmicutes</i>/<i>Bacteroidetes</i> (<i>p</i> = 0.002). <i>Conclusion</i>: Brief metronidazole followed by inulin supplementation can reduce ALT beyond that achieved after VLCD in patients with NAFLD.https://www.mdpi.com/2072-6643/12/4/937prebioticsalanine aminotransferaseantibioticOptifastgut microbiomeinulin |
| spellingShingle | Clara Yieh Lin Chong David Orr Lindsay D. Plank Tommi Vatanen Justin M. O'Sullivan Rinki Murphy Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD) Nutrients prebiotics alanine aminotransferase antibiotic Optifast gut microbiome inulin |
| title | Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD) |
| title_full | Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD) |
| title_fullStr | Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD) |
| title_full_unstemmed | Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD) |
| title_short | Randomised Double-Blind Placebo-Controlled Trial of Inulin with Metronidazole in Non-Alcoholic Fatty Liver Disease (NAFLD) |
| title_sort | randomised double blind placebo controlled trial of inulin with metronidazole in non alcoholic fatty liver disease nafld |
| topic | prebiotics alanine aminotransferase antibiotic Optifast gut microbiome inulin |
| url | https://www.mdpi.com/2072-6643/12/4/937 |
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