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Effects of silymarin on insulin resistance and sensitivity: A systematic review and meta-analysis of randomized controlled trials.

  • 2025-02
  • Diabetes research and clinical practice 220
    • Shao Yin
    • Fengya Zhu
    • Ying Liu
    • Qiu Chen

Study Design

Type
Meta-Analysis
Sample size
n = 673
Population
673 participants from Iran, Egypt, and Italy
Methods
Systematic review and meta-analysis of RCTs; searched PubMed, Embase, Web of Science, and Cochrane Library up to September 2024; silymarin supplementation for at least 4 weeks; bias risk assessed using Cochrane RoB 2; subgroup analyses based on disease type, duration, and dosage; sensitivity and publication bias analyses using Egger's and Begg's tests; analysis using Stata 15.1

Objective

This study aims to evaluate the effect of silymarin on insulin resistance and insulin sensitivity through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods

We searched PubMed, Embase, Web of Science, and Cochrane Library up to September 2024 for relevant RCTs. The intervention required silymarin supplementation for at least 4 weeks. Primary outcomes were homeostatic model assessment of insulin resistance (HOMA-IR) and fasting insulin (FI), while secondary outcomes included quantitative insulin sensitivity check index (QUICKI). Bias risk was assessed using Cochrane RoB 2. Subgroup analyses were based on disease type, duration, and dosage. Sensitivity and publication bias analyses were conducted using Egger's and Begg's tests. Statistical analysis and meta-analysis were performed using Stata 15.1.

Results

Six studies with 673 participants from Iran, Egypt, and Italy were included. All studies had low risk of bias. Meta-analysis showed that Silybum marianum significantly improved HOMA-IR (WMD = -2.29, 95 % CI: -4.55 to -0.03, p = 0.047) but had no effect on FI (WMD = -2.56, 95 % CI: -7.60 to 2.48, p = 0.862). Subgroup analyses revealed improvements in HOMA-IR for T2DM and diabetics with alcoholic cirrhosis, but no effect in non-alcoholic fatty liver disease (NAFLD) patients. QUICKI did not show significant changes in any group. Only one study reported changes in QUICKI. The results indicated that, compared to the placebo, silymarin improved insulin sensitivity in patients with type 2 diabetes mellitus (T2DM).

Conclusion

In conclusion, the results of this study indicate that there is limited evidence supporting the effectiveness of silymarin in improving HOMA-IR and FI levels in metabolic diseases, and it generally does not appear to significantly improve these parameters. Future studies should aim to increase the number of high-quality RCTs to further validate the efficacy and safety of silymarin, as well as to explore its underlying mechanisms.

Research Insights

  • Thistle→Improved Insulin Sensitivity

    QUICKI did not show significant changes in any group. Only one study reported changes in QUICKI.

    Effect
    Neutral
    Effect size
    Small
  • Thistle→Reduced HOMA-IR

    Meta-analysis showed that Silybum marianum significantly improved HOMA-IR (WMD = -2.29, 95% CI: -4.55 to -0.03, p = 0.047)

    Effect
    Beneficial
    Effect size
    Small
  • Thistle→Reduced Insulin Levels

    Meta-analysis showed that ... but had no effect on FI (WMD = -2.56, 95% CI: -7.60 to 2.48, p = 0.862)

    Effect
    Neutral
    Effect size
    Small
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