Treatment options for nonalcoholic fatty liver disease: a double-blinded randomized placebo-controlled trial

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Treatment options for nonalcoholic fatty liver disease: a double-blinded randomized placebo-controlled trial.
Anushiravani A, Haddadi N, Pourfarmanbar M, Mohammadkarimi V



Treatment options for nonalcoholic fatty liver disease: a double-blinded randomized placebo-controlled trial. - PubMed - NCBI





Abstract

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and is becoming the most frequent indication of liver transplantation. Cardiovascular disease is the main cause of death in these patients. There is no Food and Drug Association-approved medication for NAFLD patients. We aimed to provide more robust evidence on the use of medications that are inexpensive and available, namely, metformin, silymarin, pioglitazone, and vitamin E, for treating NAFLD.

MATERIALS AND METHODS:
We conducted a randomized double-blinded, placebo-controlled trial on 150 consecutive patients with NAFLD who were assigned to five groups: lifestyle plus placebo, metformin 500 mg/day, silymarin 140 mg/day, pioglithasone 15 mg/day, and vitamin E 400 IU/day, all for 3 months. Anthropometric and biochemical variables were measured at baseline and 3 months later.

RESULTS:
The mean age of the patients was 47.0±9.1 (range: 18-65) years and the sex distribution was 73 (48.7%) women and 77 (51.3%) men. Patients in all groups showed a significant improvement in anthropometric parameters such as waist circumference and BMI. There was no statistically significant difference in alanine transaminase and aspartate transaminase in the control group after treatment (P=0.51, 0.18, respectively); however, both liver enzymes decreased significantly in the other groups.

DISCUSSION AND CONCLUSION:
This randomized double-blinded placebo-controlled clinical trial suggested a significant benefit of silymarin, pioglitazone, and vitamin E in improving liver aminotransferases in patients with NAFLD after only 3 months, without exerting any specific side effects.
 

 

 
Treatment options for nonalcoholic fatty liver disease: a double-blinded randomized placebo-controlled trial.
Anushiravani A, Haddadi N, Pourfarmanbar M, Mohammadkarimi V



Treatment options for nonalcoholic fatty liver disease: a double-blinded randomized placebo-controlled trial. - PubMed - NCBI





Abstract

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and is becoming the most frequent indication of liver transplantation. Cardiovascular disease is the main cause of death in these patients. There is no Food and Drug Association-approved medication for NAFLD patients. We aimed to provide more robust evidence on the use of medications that are inexpensive and available, namely, metformin, silymarin, pioglitazone, and vitamin E, for treating NAFLD.

MATERIALS AND METHODS:
We conducted a randomized double-blinded, placebo-controlled trial on 150 consecutive patients with NAFLD who were assigned to five groups: lifestyle plus placebo, metformin 500 mg/day, silymarin 140 mg/day, pioglithasone 15 mg/day, and vitamin E 400 IU/day, all for 3 months. Anthropometric and biochemical variables were measured at baseline and 3 months later.

RESULTS:
The mean age of the patients was 47.0±9.1 (range: 18-65) years and the sex distribution was 73 (48.7%) women and 77 (51.3%) men. Patients in all groups showed a significant improvement in anthropometric parameters such as waist circumference and BMI. There was no statistically significant difference in alanine transaminase and aspartate transaminase in the control group after treatment (P=0.51, 0.18, respectively); however, both liver enzymes decreased significantly in the other groups.

DISCUSSION AND CONCLUSION:
This randomized double-blinded placebo-controlled clinical trial suggested a significant benefit of silymarin, pioglitazone, and vitamin E in improving liver aminotransferases in patients with NAFLD after only 3 months, without exerting any specific side effects.
I believe choline and inositol are also effectively used for this purpose.
 
Milk Thistle Seed Extract (containing Silymarin) is a standard herb for liver problems. Many reviews on Amazon claiming benefit decreasing liver enzymes. However, liver biopsies or some kind of imaging are needed to see if that correlates with actual improvement in fatty liver or is just an antioxidant effect decreasing liver metabolism/enzymes. The claim that plain old vit E improved enzymes is probably true but casts doubt on the actual therapeutic value.

Also, 'statistically significant decrease in enzymes' does not always mean a substantial decrease. Older medical articles always report the actual decrease in numbers, but the new ones often give only the 'statistically significant' mambo jumbo, which is not very helpful.
 
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Does Sunflower Lecithin have the same sexual and other health benefits as Soy Lecithin?
 

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Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

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