Abstract
OBJECTIVE: Metabolic-associated fatty liver disease (MASLD) is a growing global health concern. From the standpoint of preventive and personalized medicine, understanding the early determinants and modifiable risk factors is essential for targeted prevention and personalized treatment strategies. This study aimed to evaluate the specific association between probiotics/prebiotics and the occurrence of MASLD, contributing to the development of innovative preventive measures and personalized therapeutic approaches. METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. The study employed logistic regression analysis to examine the relation between MASLD and probiotics/prebiotics. The efficacy of various MASLD predictive models was assessed using receiver operating characteristic (ROC) curves. A meta-analysis was conducted by searching databases up to 4 May 2024. The analysis included randomized controlled trials of liver function in patients with MASLD or nonalcoholic steatohepatitis treated with probiotics, prebiotics, or yogurt for a minimum of 6 months. RESULTS: A total of 5014 adults from NHANES were included in this study, with a weighted prevalence of MASLD observed at 24.47%. MASLD adults who consumed both probiotics and prebiotics exhibited a reduced risk of MASLD (OR = 0.71, 95% CI: 0.53 to 0.94). The use of probiotics/prebiotics can enhance the simplicity and practicality of the model. Model 1, adjusted for sex, BMI, race, and HEI-2015, achieved an area under the curve (AUC) of 0.8544, while Model 2, adjusted for sex, BMI, race, and prebiotics/probiotics use, showed a similar AUC of 0.8537. The comparison between the two models revealed no statistically significant difference (0.8544 vs. 0.8537; 95% CI: - 0.0010 to 0.0025; Z = 0.8332; p = 0.4047). Subgroup analysis of the NHANES data revealed that individuals aged 40 and older benefit from consuming probiotics or prebiotics. Furthermore, the meta-analysis demonstrated that probiotic or prebiotic interventions resulted in significant improvements in biochemical markers, including alanine aminotransferase, aspartate aminotransferase, low-density lipoprotein cholesterol, and triglycerides. CONCLUSIONS: The consumption of probiotics/prebiotics has been linked to a reduced risk of developing MASLD in adults. Integrating probiotics/prebiotics into early intervention and personalized treatment plans may facilitate targeted prevention and management of MASLD, promoting a more individualized approach to disease prevention and care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13167-025-00398-4.