Efficacy of different interventions for nonalcoholic fatty liver disease: A meta-analysis of lifestyle modifications, silymarin, and medications.
- 2025-08-01
- Asia Pacific journal of clinical nutrition 34(4)
- Zhen Zhang
- Shuai Li
- Jianjun Sun
- PubMed: 40738719
- DOI: 10.6133/apjcn.202508_34(4).0003
Study Design
- Type
- Meta-Analysis
- Sample size
- n = 2,283
- Population
- 25 studies with 2283 patients
- Methods
- Systematic review and meta-analysis of PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov; comparing silymarin or its combination with lifestyle modifications, Mediterranean hypocaloric diets, and medications vs placebo or other comparators
Background and objectives
To compare the effectiveness of silymarin or its combination with lifestyle modifications, Mediterranean hypocaloric diets, and medications for improving nonalcoholic fatty liver disease (NAFLD).Methods and study design
PubMed, Embase, Cochrane Library, Web of Science, and Clin-icalTrails.gov were used to identify relevant studies. The treatment arm was silymarin or its combination with Mediterranean hypocaloric diets, medications, or lifestyle modifications. The comparators were placebo, Mediterranean hypocaloric diets, medications, and lifestyle modifications.Results
This meta-analysis included 25 studies with 2283 patients. Total cholesterol levels were reduced by silymarin+Mediterranean hypocaloric diets (SMD: -0.39 (-0.81, 0.03), p=0.072) or medications [SMD: -1.12 (-1.67, -0.58), p<0.001]. Triglyceride levels were decreased by silymarin combined with the medication [SMD: -0.92 (-1.98, 0.14), p=0.080]. Low-density lipoprotein cholesterol levels were reduced by silymarin alone [SMD: -0.25 (-0.48, -0.03), p=0.027]. The combination of silymarin with Mediterranean hypocaloric diets [SMD: -0.47 (-0.90, -0.04), p=0.031] or lifestyle modifications [SMD: -0.88 (-1.09, -0.66), p<0.0001] decreased alanine aminotransferase levels. Aspartate aminotransferase levels were reduced by a combination of silymarin and life-style modifications [SMD: -0.72 (-1.49, 0.05), p=0.061] or medications [SMD: -1.41 (-2.24, -0.59), p=0.005]. Silymarin (2.5 times) or silymarin plus lifestyle modifications (39%) reduced the hepatic steatosis rate in patients with NAFLD. The silymarin use increased the rate of patients with adverse effects [RR:1.98 (1.11, 3.54)]; gastrointestinal problems were the most common adverse effects.Conclusions
Despite the overall advantages of therapies, different interventions showed different effects on markers in patients with NAFLD. These results highlight the need for more research to fully comprehend the features of the intervention.Research Insights
The combination of silymarin with Mediterranean hypocaloric diets [SMD: -0.47 (-0.90, -0.04), p=0.031] or lifestyle modifications [SMD: -0.88 (-1.09, -0.66), p<0.0001] decreased alanine aminotransferase levels.
- Effect
- Beneficial
- Effect size
- Moderate
or medications [SMD: -1.41 (-2.24, -0.59), p=0.005].
- Effect
- Beneficial
- Effect size
- Large
Silymarin (2.5 times) or silymarin plus lifestyle modifications (39%) reduced the hepatic steatosis rate in patients with NAFLD.
- Effect
- Beneficial
- Effect size
- Large
Low-density lipoprotein cholesterol levels were reduced by silymarin alone [SMD: -0.25 (-0.48, -0.03), p=0.027].
- Effect
- Beneficial
- Effect size
- Small
Total cholesterol levels were reduced by silymarin+Mediterranean hypocaloric diets (SMD: -0.39 (-0.81, 0.03), p=0.072)
- Effect
- Neutral
- Effect size
- Small
Triglyceride levels were decreased by silymarin combined with the medication [SMD: -0.92 (-1.98, 0.14), p=0.080].
- Effect
- Neutral
- Effect size
- Small
Adverse Events Reported
The silymarin use increased the rate of patients with adverse effects [RR:1.11, 3.54]
- Finding
- Increased risk
- Magnitude
- RR: 1.11, 3.54
- Significant
- Yes
gastrointestinal problems were the most common adverse effects.
- Finding
- Reported