Overall, administration of 400 IU alpha-tocopherol and symbiotic supplements containing Lactobacillus casei, Lactobacillus rhamnosus, Stretococcus thermophilus, Bifidobacterium breve, Lactobacillus acidophilus, Bifidobacterium longum, and Lactobacillus bulgaricus for 8 weeks among patients with NAFLD had beneficial effects on systolic SBP, MDA and TNFα but did not affect DBP and serum NO levels compared with the control group. Here, TNF is linked to metabolic dysfunction-associated steatotic liver disease.