The choice of therapy is crucial for the effective management of NAFLD. Physicians can suggest probiotics therapy for improving liver cell damage, lipid metabolism and reducing the content of cholesterol and blood lipids.

This systematic review and network meta-analysis was carried out to evaluate the different interventions used for the management of non-alcoholic fatty liver disease (NAFLD) to provide a suitable treatment choice for physicians.

An extensive literature search was done on PubMed, Medline, Embase and Cochrane Library databases to find the relevant randomized controlled trials from January 2013 to January 2023. The network meta-analysis was accomplished as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

A total of 43 studies comprising 2969 patients were included. Outcome measures consisted of total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, and alanine aminotransferase (ALT) for examination and evaluation.

The consequences of pharmacological therapy, dietary regimen and lifestyle interventions amongst the intervention and control groups (placebo) were evaluated. Curcumin (natural polyphenol obtained from turmeric) and probiotics (symbiotic microorganisms) were considered for therapy, Mediterranean food was considered as a special diet, and numerous exercise and lifestyle advice were considered for lifestyle interventions.

The surface under the cumulative ranking curve (SUCRA) was used to rank interventions based on the three outcome measures, as shown in the following Table 1:

The Mediterranean diet was considerably better compared to no treatment in improving ALT (standardized mean difference [SMD] 1.99) as per the results of the pairwise meta-analysis. Acceptance of theoretical suggestions (ATS; a part of lifestyle interventions) was considerably better compared to no treatment for the improvement of TC and LDL.

The use of probiotic therapy was found to be the most effective intervention to improve NAFLD indicators. Expert advice on dietary modifications or exercise (workout) was a more effective non-pharmacological therapy for NAFLD compared to no intervention.