Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common complication of obesity. Gut dysbiosis is implicated in the pathogenesis of NAFLD.

Objective: To investigate the effect of synbiotic supplementation in children with NAFLD.

Materials and Methods: This was a randomized, double-blind, placebo-controlled trial conducted during February to October 2016. All subjects had NAFLD defined by controlled attenuation parameter (CAP) value of greater than 225 dB/m without other causes of fatty liver. Participants received either a mixture of chicory inulin, Lactobacillus acidophilus, and Bifidobacterium lactis or placebo for 16 weeks. Body mass index (BMI), serum alanine transaminase (ALT), and liver stiffness measurement (LSM) with simultaneous CAP determination were assessed at baseline and after the completion of the intervention. Body mass index Z-score adjusted for age and sex was determined according to the 2007 WHO child growth references.

Results: There were 18 (78% male) and 19 (58% male) children in synbiotic and placebo groups. Children in intervention group had significantly greater mean age than those in placebo group (13.3+2.1 vs. 11.26+2.7 years, p = 0.02). There was no difference of baseline BMI Z-score, serum ALT, CAP, and LSM between the two groups. After the completion of the intervention, BMI Z-score significantly decreased in both groups. The reduction of CAP value tended to be significant in the placebo group (p = 0.047). The median (IQR) between-group difference in change from baseline for BMI Z-score, serum ALT, CAP, and LSM values were not statistically significant.

Conclusion: The present study is unable to demonstrate the beneficial effect of this particular synbiotic on BMI and hepatic derangement in children with NAFLD. The search for appropriate prebiotic type, dosage and strain of probiotic as well as the duration of treatment for pediatric NAFLD is still required.