The Additive Effect of Herbal Medicines on Lifestyle Modification in the Treatment of Non-alcoholic Fatty Liver Disease: a Systematic Review and Meta-analysis

Overview

Journal Front Pharmacol

Date 2024 Mar 11

PMID 38464716

Authors

Myung-Ho Kim

Subin Ahn

Nayeon Hur

Seung-Yun Oh

Chang-Gue Son

Affiliations

Soon will be listed here.

Abstract

Non-alcoholic fatty liver disease (NAFLD) is difficult to manage because of its complex pathophysiological mechanism. There is still no effective treatment other than lifestyle modification (LM) such as dietary modifications, regular physical activity, and gradual weight loss. Herbal medicines from traditional Chinese Medicine and Korean Medicine have been shown to be effective in the treatment of NAFLD based on many randomized controlled trials. This systematic review and meta-analysis aims to evaluate the additive effects of herbal medicines on LM in the treatment of NAFLD. Two databases (PubMed and Cochrane library) were searched using keywords related to NAFLD and herbal medicines. Then the randomized controlled trials (RCTs) evaluating the therapeutic effects of herbal medicines combined with LM were selected. The pooled results were analyzed as mean difference (MD) with 95% confidence interval (CI) for continuous data, and risk ratio (RR) with 95% CI for dichotomous data. Eight RCTs with a total of 603 participants were included for this review study. Participants were administered with multi-herbal formulas (Yiqi Sanju Formula, Tiaogan Lipi Recipe, and Lingguizhugan Decoction) or single-herbal extracts (Glycyrrhiza glabra L., Magnoliae offcinalis, Trigonella Foenum-graecum L. semen, Portulaca oleracea L., and Rhus Coriaria L. fructus) along with LM for 12 weeks. The meta-analysis showed a significant improvement in ultrasoundbased liver steatosis measured by odds ratio (OR) in the herbal medicine group than those with LM alone (OR = 7.9, 95% CI 0.7 to 95.2, < 0.1). In addition, herbal medicines decreased the levels of aspartate transferase (MD -7.5, 95% CI -13.4 to -1.7, = 0.01) and total cholesterol (MD -16.0, 95% CI -32.7 to 0.7, = 0.06) more than LM alone. The meta-analysis partially showed clinical evidence supporting the additive benefits of herbal medicines for NAFLD in combination with LM. Whereas, it is necessary to provide a solid basis through higher-quality studies using a specific herbal medicine.

References

Fernando D, Forbes J, Angus P, Herath C . Development and Progression of Non-Alcoholic Fatty Liver Disease: The Role of Advanced Glycation End Products. Int J Mol Sci. 2019; 20(20). PMC: 6834322. DOI: 10.3390/ijms20205037. View

Andreasen C, Andersen A, Vilsboll T . The future of incretins in the treatment of obesity and non-alcoholic fatty liver disease. Diabetologia. 2023; 66(10):1846-1858. DOI: 10.1007/s00125-023-05966-9. View

Dong X, Fu J, Yin X, Yang C, Zhang X, Wang W . Cassiae semen: A review of its phytochemistry and pharmacology (Review). Mol Med Rep. 2017; 16(3):2331-2346. PMC: 5547955. DOI: 10.3892/mmr.2017.6880. View

Younossi Z, Anstee Q, Marietti M, Hardy T, Henry L, Eslam M . Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2017; 15(1):11-20. DOI: 10.1038/nrgastro.2017.109. View

Liu J, Zhang Q, Li R, Wei S, Huang C, Gao Y . The traditional uses, phytochemistry, pharmacology and toxicology of Cinnamomi ramulus: a review. J Pharm Pharmacol. 2019; 72(3):319-342. DOI: 10.1111/jphp.13189. View

Yadav U, Baquer N . Pharmacological effects of Trigonella foenum-graecum L. in health and disease. Pharm Biol. 2013; 52(2):243-54. DOI: 10.3109/13880209.2013.826247. View

Segura-Azuara N, Varela-Chinchilla C, Trinidad-Calderon P . MAFLD/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis. Front Med (Lausanne). 2022; 8:774079. PMC: 8792949. DOI: 10.3389/fmed.2021.774079. View

Schwenzer N, Springer F, Schraml C, Stefan N, Machann J, Schick F . Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol. 2009; 51(3):433-45. DOI: 10.1016/j.jhep.2009.05.023. View

Kazemi S, Shidfar F, Ehsani S, Adibi P, Janani L, Eslami O . The effects of sumac (Rhus coriaria L.) powder supplementation in patients with non-alcoholic fatty liver disease: A randomized controlled trial. Complement Ther Clin Pract. 2020; 41:101259. DOI: 10.1016/j.ctcp.2020.101259. View

10.

Jeong J, Sohn J, Baek Y, Cho Y, Kim Y, Kim H . New botanical drug, HL tablet, reduces hepatic fat as measured by magnetic resonance spectroscopy in patients with nonalcoholic fatty liver disease: A placebo-controlled, randomized, phase II trial. World J Gastroenterol. 2017; 23(32):5977-5985. PMC: 5583583. DOI: 10.3748/wjg.v23.i32.5977. View

11.

Xue Q, Wang Y, Fei C, Ren C, Li W, Li W . Profiling and analysis of multiple constituents in Crataegi Fructus before and after processing by ultrahigh-performance liquid chromatography quadrupole time-of-flight mass spectrometry. Rapid Commun Mass Spectrom. 2020; 35(7):e9033. DOI: 10.1002/rcm.9033. View

12.

Wang J, Wang L, Lou G, Zeng H, Hu J, Huang Q . Coptidis Rhizoma: a comprehensive review of its traditional uses, botany, phytochemistry, pharmacology and toxicology. Pharm Biol. 2019; 57(1):193-225. PMC: 6461078. DOI: 10.1080/13880209.2019.1577466. View

13.

Wang F, Zhang S, Zhang J, Yuan F . Systematic review of ethnomedicine, phytochemistry, and pharmacology of . Front Pharmacol. 2022; 13:965902. PMC: 9585201. DOI: 10.3389/fphar.2022.965902. View

14.

Baradaran Rahimi V, Ajam F, Rakhshandeh H, Askari V . A Pharmacological Review on L.: Focusing on Anti-Inflammatory, Anti- Oxidant, Immuno-Modulatory and Antitumor Activities. J Pharmacopuncture. 2019; 22(1):7-15. PMC: 6461301. DOI: 10.3831/KPI.2019.22.001. View

15.

Krawczyk M, Liebe R, Lammert F . Toward Genetic Prediction of Nonalcoholic Fatty Liver Disease Trajectories: PNPLA3 and Beyond. Gastroenterology. 2020; 158(7):1865-1880.e1. DOI: 10.1053/j.gastro.2020.01.053. View

16.

Babaei A, Taghavi S, Mohammadi A, Mahdiyar M, Iranpour P, Ejtehadi F . Comparison of the efficacy of oral fenugreek seeds hydroalcoholic extract versus placebo in nonalcoholic fatty liver disease; a randomized, triple-blind controlled pilot clinical trial. Indian J Pharmacol. 2020; 52(2):86-93. PMC: 7282687. DOI: 10.4103/ijp.IJP_17_19. View

17.

Lou S, Liu Y, Ma Y, Chen H, Chen W, Ying J . [Effects of Yiqi Sanju Formula on non-alcoholic fatty liver disease: a randomized controlled trial]. Zhong Xi Yi Jie He Xue Bao. 2008; 6(8):793-8. DOI: 10.3736/jcim20080805. View

18.

Riazi K, Azhari H, Charette J, Underwood F, King J, Afshar E . The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022; 7(9):851-861. DOI: 10.1016/S2468-1253(22)00165-0. View

19.

Lim S, Kim J, Targher G . Links between metabolic syndrome and metabolic dysfunction-associated fatty liver disease. Trends Endocrinol Metab. 2021; 32(7):500-514. DOI: 10.1016/j.tem.2021.04.008. View

20.

Yu Q, Zhang S, Zhou T, Xiong Y, Zhao L, Ding Y . [Treating non-alcoholic fatty liver disease patients of Gan stagnation Pi deficiency syndrome by tiaogan lidi recipe: a randomized controlled clinical trial]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2015; 35(4):401-5. View