Adjunctive Therapy with KestoMix in Metabolic Dysfunction-Associated Fatty Liver Disease
Keywords:
prebiotics; fatty liver disease associated with metabolic dysfunction; fructooligosaccharides; hepatic steatosis; adjuvant therapyAbstract
Introduction: Prebiotics are proposed as a therapeutic approach for the fatty liver disease associated with metabolic dysfunction. KestoMix is a prebiotic containing 55% fructooligosaccharides; its main component is 1-kestose.
Objective: To determine the effect of KestoMix on anthropometric parameters, blood biochemistry, and hepatic echogenicity in patients with this disease.
Methods: A randomized, controlled, interventional clinical study was conducted at the General Hospital Camilo Cienfuegos, in Sancti Spíritus. Forty-three patients were randomly assigned: 21 to the control group (n=21), which received standard management and 22 to the intervention group (n=22), to which KestoMix (7.2g three times per day) was added for 36 weeks. The evaluators of the liver ultrasound and biochemical analysis were blinded to group allocation. Assessments were performed at baseline and at 36 weeks.
Results: Weight and body mass index decreased in both groups, and the waist-to-hip ratio decreased in the intervention group. KestoMix intake reduced alanine aminotransferase and aspartate aminotransferase levels (p<0.050) and improved serum triacylglycerides compared to the control group (p=0.027) and to baseline levels (p=0.001). At 36 weeks, 72.7% of patients in the intervention group improved their steatosis grade to normal/mild, compared with 33.3% in the control group; a significant difference between groups (p=0.027).
Conclusions: It was demonstrated that KestoMix improved anthropometric parameters, blood biochemistry, and hepatic steatosis in patients with the disease.
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1. Riazi K, Azhari H, Charette JH, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7(9):851-61. DOI: 10.1016/S2468-1253(22)00165-0.
2. Carpi RZ, Barbalho SM, Sloan KP, et al. The effects of probiotics, prebiotics and synbiotics in non-alcoholic fat liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): A systematic review. Int J Mol Sci. 2022;23(15):8805. DOI: 10.3390/ijms23158805.
3. Rong L, Zou J, Ran W, et al. Advancements in the treatment of non-alcoholic fatty liver disease (NAFLD). Front Endocrinol. 2023;13:1087260. DOI: 10.3389/fendo.2022.1087260.
4. Aron-Wisnewsky J, Warmbrunn MV, Nieuwdorp M, et al. Nonalcoholic fatty liver disease: modulating gut microbiota to improve severity? Gastroenterology. 2020;158(7):1881-98. DOI: 10.1053/j.gastro.2020.01.049.
5. Chu NHS, Chow E, Chan JCN. The therapeutic potential of the specific intestinal microbiome (SIM) diet on metabolic diseases. Biology. 2024;13(7):498. DOI: 10.3390/biology13070498.
6. Hernández L, Menéndez C, Pérez ER, et al. Fructooligosaccharides production by Schedonorus arundinaceus sucrose: sucrose 1-fructosyltransferase constitutively expressed to high levels in Pichia pastoris. J Biotechnol. 2018;266:59-71. DOI: 10.1016/j.jbiotec.2017.12.008.
7. García G, Martínez D, Soto J, et al. Short-chain fructooligosaccharides improve gut microbiota composition in patients with type 2 diabetes: a randomized, open-label, controlled pilot clinical trial. J Biotechnol Biomed. 2023;6(2):244-58. DOI: 10.26502/jbb.2642-91280087.
8. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Obes Facts. 2024;17(6):374-444. DOI: 10.1159/000539371.
9. Chan DF, Li AM, Chu WC, et al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord. 2004;28(10):1257-63. Doi: 10.1038/sj.ijo.0802734.
10. Abd El Hamid AA, Mohamed AE, Mohamed MS, et al. The effect of probiotic supplementation on non-alcoholic fatty liver disease (NAFLD) fibrosis score in patients attending a tertiary hospital clinic in Cairo, Egypt. MC Gastroenterol. 2024;24(1):354. DOI: 10.1186/s12876-024-03424-3.
11. Valerio Rao BG. Probióticos y prebióticos como potenciales modificadores del microbioma intestinal en el tratamiento de la enfermedad hepática esteatósica asociada a disfunción metabólica: Revisión sistemática [Internet]. Madrid: Universidad Europea; 2023 [citado 09/10/2025]. Disponible en: https://titula.universidadeuropea.com/bitstream/handle/20.500.12880/7429/TFM_Grecia%20Bell_Valerio%20Rao.pdf?sequence=1&isAllowed=y
12. Bomhof MR, Parnell JA, Ramay HR, et al. Mejoría histológica de la esteatohepatitis no alcohólica con un prebiótico: un ensayo clínico piloto. Eur J Nutr. 2019;58(4):1735-45. DOI: 10.1007/s00394-018-1721-2.
13. Lu S, Xie Q, Kuang M, et al. Lipid metabolism, BMI and the risk of nonalcoholic fatty liver disease in the general population: evidence from a mediation analysis. J Transl Med. 2023;21(1):192. DOI: 10.1186/s12967-023-04047-0.
14. Jara Ramón XO, Orellana Bernal PV. Actualización del abordaje farmacológico de la enfermedad esteatósica asociada a disfunción metabólica. Salud ConCiencia [Internet]. 2023 [citado 09/10/2025];2(2):e20. Disponible en: https://dspace.ucacue.edu.ec/server/api/core/bitstreams/a0ff6d8c-2cd0-4f98-aa74-6f02d021b151/content
15. Wang Y, Wang Y, Sun J. The clinical effect of probiotics on patients with non-alcoholic fatty liver disease: a meta-analysis. Bioengineered. 2022;13(7-12):14960-73. DOI: 10.1080/21655979.2023.2185941.
16. Rong L, Ch'ng D, Jia P, et al. Use of probiotics, prebiotics, and synbiotics in non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2023;38(8):1682-94. DOI: 10.1111/jgh.16256.
17. Latcu OC, Hamamah S, Covasa M. Harnessing prebiotics to improve type 2 diabetes outcomes. Nutrients. 2024;16(20):3447. DOI: 10.3390/nu16203447.
18. Bonsu NKA, Johnson S. Efectos de la suplementación con fibra de inulina en la concentración sérica de glucosa y lípidos en pacientes con diabetes tipo 2. Int J Diabetes Metab. 2019;20(3):80-6. DOI: 10.1159/000497730.
19. Di Primio AN, Duca G, Rubio C. Actividad de los fructooligosacáridos como prebiótico y efectos sobre el tracto intestinal. Biotecnología [Internet]. 2021 [citado 09/10/2025];25(1):10-20. Disponible en: https://smbb.mx/wp-content/uploads/2021/05/Di-Primio-et-al-2021.pdf
20. Dou Y, Yu X, Luo Y, et al. Effect of fructooligosaccharides supplementation on the gut microbiota in humans: a systematic review and meta-analysis. Nutrients. 2022;14(6):3298. DOI: 10.3390/nu14163298.
21. Huang X, Chen Q, Fan Y, et al. Fructooligosaccharides attenuate non-alcoholic fatty liver disease by remodeling gut microbiota and association with lipid metabolism. Biomed Pharmacother. 2023;159:114300. DOI: 10.1016/j.biopha.2023.114300.
22. Bezan PN, Holland H, Vercesi BF, et al. Fructooligosaccharides supplementation: a good choice for the prevention and treatment of non-alcoholic fatty liver disease? Appl Biosci. 2024;3(1):123-36. DOI: 10.3390/applbiosci3010008.
23. Salguero MV, Al-Obaide M, Singh R, et al. Dysbiosis of gram-negative gut microbiota and the associated serum lipopolysaccharide exacerbates inflammation in type 2 diabetic patients with chronic kidney disease. Exp Ther Med. 2019;18(5):3461-9. DOI: 10.3892/etm.2019.7943.
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Copyright (c) 2026 Mirian Belkis Nápoles-Valdés, Miguel Ángel Amaró-Garrido, Kendra Carrazana-Román, Duniesky Martínez-García
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