Three months of Lactobacillus rhamnosus lysate DV-NRRL B-68023 was well tolerated; among the three registered co-primary surrogate indices, only FLI showed a nominal between-group difference (HSI and TyG did not), with an exploratory reduction in waist circumference while ALT and AST changes were not significantly different from placebo.
The Fatty Liver Index (FLI) showed a nominal time-by-treatment interaction favoring the postbiotic in the ITT analysis.
The other two registered co-primary endpoints, the Hepatic Steatosis Index (HSI) and the triglyceride-glucose index (TyG), did not differ significantly between groups.
Waist circumference showed a significant time-by-treatment interaction in exploratory ITT analyses, whereas visceral fat did not.
ALT and AST decreased significantly within the postbiotic group, but changes were not significantly different from placebo.
Lipid parameters and hs-CRP did not differ significantly between the postbiotic and placebo groups.
The postbiotic was well tolerated, with only mild, self-limiting adverse events.
The authors conclude that the findings require confirmation in larger studies using direct liver assessments and longer follow-up.
This study tested whether a supplement made of dead (non-viable) Lactobacillus rhamnosus bacteria components, called a postbiotic, could help people with metabolic dysfunction-associated steatotic liver disease (fatty liver). Fifty-two adults were randomly assigned to take either the supplement (100 mg twice a day) or a placebo for three months, followed by three months without treatment. Neither participants nor researchers knew who received which. The results were mixed and modest. Of three pre-registered main measures of liver fat (all calculated from routine measurements rather than direct imaging or biopsy), only the Fatty Liver Index improved more with the supplement than placebo, and that result was only borderline (p = 0.049). The other two measures did not differ. Waist circumference dropped more in the supplement group in an exploratory analysis. Liver enzymes (ALT and AST) fell within the supplement group, but not significantly more than with placebo. Cholesterol-related measures and an inflammation marker did not differ between groups. Side effects were mild and went away on their own. This research suggests the postbiotic is safe over three months but provides only limited evidence of benefit for fatty liver. Because the trial was small, short, and used indirect measures of liver fat, the authors say larger and longer studies with direct liver assessments are needed to confirm whether it truly helps.
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Upload Your LabsSavytska M, Ilkiv Y, Baka O, Christian E, Yerokhovych V, Kyriienko D, et al.. (2026). Lactobacillus rhamnosus Lysate for Metabolic Dysfunction-Associated Steatotic Liver Disease: A Randomized Controlled Trial.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62101893