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Synbiotics show modest effects in non-alcoholic fatty liver disease (NAFLD). These effects are inconsistent. Synbiotics also impact metabolic dysfunction-associated fatty liver disease (MAFLD/MASLD). They work mainly by modulating the gut-liver axis and improve liver enzymes and lipid metabolism. Some imaging-based steatosis markers also show improvement. However, evidence is limited. Trials are relatively small and short-term. Not all studies show clear improvements. Liver fat or fibrosis improvements are not always evident on imaging or histology