Herbal treatments for non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

Background: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD), there is a growing need to explore alternative therapeutic interventions. This study aimed to comprehensively evaluate the available evidence from randomized controlled trials (RCTs) for the use of herbal medications in NAFLD. 

Methods: A literature search was conducted in PubMed, Web of Science and Scopus databases using appropriate keywords for studies published before the 6th of July 2023. RCTs involving humans, with confirmed NAFLD, the intervention group (IG) receiving herbal treatment, the control group (CG) given a placebo, participants aged ≥18 years, published in English, and a Jadad score ≥6 were included. Coffee and green tea as interventions were excluded. A meta-analysis of studies examining the effects of herbal supplementation on clinical and biochemical parameters in patients with NAFLD was performed. Analysis was done with the “meta” package in R programming language version 4.3. 

Results: In this analysis encompassing 48 articles, study durations varied from 6 weeks to 12 months, with sample sizes ranging between 36 and 226 patients. The study included a total of 3741 patients, (IG=2013, CG=1728). Predominant single herbal medicines identified were Phyllanthus niruri, Beta vulgaris, Allium sativum L., Silymarin (Silybum marianum), Portulaca oleracea L., Nigella sativa, and Cynara cardunculus L. Meanwhile, Cynara cardunculus and curcumin were the most common ingredients in polyherbal compounds. Meta-analysis outcomes revealed a higher reduction in alanine aminotransferase (ALT), aspartate aminotransferase (AST), liver stiffness, waist circumference (WC), weight, body mass index (BMI), triglycerides (TG), and fasting blood glucose (FBG) in the IG compared to the CG. Notably, the reductions in ALT and weight were more pronounced in single herb compounds compared to polyherbal compounds. No differences were observed between the two groups regarding HbA1c levels.

Conclusion: These findings highlight the potential benefits of herbal interventions with regard to improvements in anthropometry, metabolic profiles, and liver enzymes in study participants.