TNF and metabolic dysfunction-associated steatohepatitis: Malaguarnera et al. observed that combination of synbiotic (B. longum and Fos) and lifestyle intervention in NASH patients resulted in a much greater improvement compared to lifestyle intervention alone, including reduction of serum TNFα, CRP (C-reactive protein), endotoxin, and AST levels, improvement in HOMA-IR( homeostasis model assessment of insulin resistance)and extent of NASH activity index [151].