Effect of Mastiha supplementation on NAFLD: The MAST4HEALTH Randomised, Controlled Trial.

2021-04-16
Molecular nutrition & food research 65(10)
- Charalampia Amerikanou
- Stavroula Kanoni
- Andriana C Kaliora
- Angela Barone
- Mladen Bjelan
- Giuseppe D'Auria
- Aristea Gioxari
- María José Gosalbes
- Sofia Mouchti
- Maria G Stathopoulou
- Beatriz Soriano
- Stefan Stojanoski
- Rajarshi Banerjee
- Maria Halabalaki
- Eleni V Mikropoulou
- Aimo Kannt
- John Lamont
- Carlos Llorens
- Fernando Marascio
- Miriam Marascio
- Francisco J Roig
- Ilias Smyrnioudis
- Iraklis Varlamis
- Sophie Visvikis-Siest
- Milan Vukic
- Natasa Milic
- Milica Medic-Stojanoska
- Lucia Cesarini
- Jonica Campolo
- Amalia Gastaldelli
- Panos Deloukas
- Maria Giovanna Trivella
- M Pilar Francino
- George V Dedoussis

PubMed: 33629536
DOI: 10.1002/mnfr.202001178

Study Design

Type: Randomized Controlled Trial (RCT)
Population: 98 patients with NAFLD in three countries (Greece, Italy, Serbia)
Methods: Multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial; patients randomly allocated to either Mastiha or Placebo for 6 months; assessment via MRI scanning and LiverMultiScan technique, medical, anthropometric, biochemical, metabolomic, and microbiota assessment
Blinding: Double-blind
Duration: 6 months

Rigorous Journal

Scope

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease with poor therapeutic strategies. Mastiha possesses antioxidant/anti-inflammatory and lipid-lowering properties. The authors investigate the effectiveness of Mastiha as a nonpharmacological intervention in NAFLD.

Methods and results

Ninety-eight patients with NAFLD in three countries (Greece, Italy, Serbia) are randomly allocated to either Mastiha or Placebo for 6 months, as part of a multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial. The authors assess NAFLD severity via magnetic resonance imaging (MRI) scanning and LiverMultiScan technique and evaluate the effectiveness of Mastiha through medical, anthropometric, biochemical, metabolomic, and microbiota assessment. Mastiha is not superior to Placebo on changes in iron-corrected T1 (cT1) and Liver Inflammation Fibrosis score (LIF) in entire patient population; however, after BMI stratification (BMI ≤ 35 kg m^-2 and BMI > 35 kg m^-2 ), severely obese patients show an improvement in cT1 and LIF in Mastiha versus Placebo. Mastiha increases dissimilarity of gut microbiota, as shown by the Bray-Curtis index, downregulates Flavonifractor, a known inflammatory taxon and decreases Lysophosphatidylcholines-(LysoPC) 18:1, Lysophosphatidylethanolamines-(LysoPE) 18:1, and cholic acid compared to Placebo.

Conclusion

Mastiha supplementation improves microbiota dysbiosis and lipid metabolite levels in patients with NAFLD, although it reduces parameters of liver inflammation/fibrosis only in severely obese patients.

Research Insights

Mastic→Increased Gut Microbiota Dissimilarity
Mastiha increases dissimilarity of gut microbiota, as shown by the Bray-Curtis index
Effect
Beneficial
Effect size
Small
Mastic→Reduced Cholic Acid Level
decreases Lysophosphatidylcholines-(LysoPC) 18:1, Lysophosphatidylethanolamines-(LysoPE) 18:1, and cholic acid compared to Placebo
Effect
Beneficial
Effect size
Small
Mastic→Reduced Flavonifractor Abundance
downregulates Flavonifractor, a known inflammatory taxon
Effect
Beneficial
Effect size
Small
Mastic→Reduced Iron-Corrected T1
after BMI stratification (BMI ≤ 35 kg m⁻² and BMI > 35 kg m⁻²), severely obese patients show an improvement in cT1 and LIF in Mastiha versus Placebo
Effect
Beneficial
Effect size
Small
Mastic→Reduced Liver Inflammation Fibrosis Score
after BMI stratification (BMI ≤ 35 kg m⁻² and BMI > 35 kg m⁻²), severely obese patients show an improvement in cT1 and LIF in Mastiha versus Placebo
Effect
Beneficial
Effect size
Small
Mastic→Reduced Lysophosphatidylcholine 18:1 Level
decreases Lysophosphatidylcholines-(LysoPC) 18:1, Lysophosphatidylethanolamines-(LysoPE) 18:1, and cholic acid compared to Placebo
Effect
Beneficial
Effect size
Small
Mastic→Reduced Lysophosphatidylcholine Level
decreases Lysophosphatidylcholines-(LysoPC) 18:1 compared to Placebo
Effect
Beneficial
Effect size
Small
Mastic→Reduced Lysophosphatidylethanolamine 18:1 Level
decreases Lysophosphatidylcholines-(LysoPC) 18:1, Lysophosphatidylethanolamines-(LysoPE) 18:1, and cholic acid compared to Placebo
Effect
Beneficial
Effect size
Small
Mastic→Reduced Lysophosphatidylethanolamine Level
decreases Lysophosphatidylethanolamines-(LysoPE) 18:1 compared to Placebo
Effect
Beneficial
Effect size
Small