The effects of curcumin supplementation on liver function,metabolic profile and body composition in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

BackgroundNon-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. Curcumin is the anti-inflammatory, antioxidant, anti-diabetic and also anti-hyperlipidemia agent and uses as herbal medicine for treating liver diseases.ObjectiveThe present systematic review and meta-analysis was conducted to investigate the effects of curcumin supplementation on metabolic markers and anthropometric parameters in patients with (NAFLD).MethodsPubMed, Embase, Scopus, Web of Science and Cochrane Library were systematically searched to identify relevant randomized controlled trials (RCTs) investigating the effects of curcumin supplementation on the arms of this study in patients with NAFLD up to September 2019. Mean difference (MD) was pooled using a random effects model. Potential publication bias was assessed using Egger's weighted regression tests.ResultsAfter excluding irrelevant records, 9 RCTs included in this meta-analysis. Pooled results of included studies indicated a significant reduction in alanine transaminase (ALT), aspartate transaminase (AST), serum total cholesterol (TC), low density lipoprotein (LDL), fasting blood sugar (FBS), HOMA-IR, serum insulin and waist circumference (WC), but not in serum triglyceride (TG), high density lipoprotein (HDL), HbA1c, body weight and body mass index (BMI) following curcumin supplementation. Additionally, age- and baseline TC-based subgroup analysis indicated a significant reduction in TG and also duration- and dosage-based showed a significant change in BMI.ConclusionThe current study revealed that curcumin supplementation has favorable effect on metabolic markers and anthropometric parameters in patients with NAFLD.     

Nigella sativa and inflammatory biomarkers in patients with non-alcoholic fatty liver disease: Results from a randomized,double-blind,placebo-controlled,clinical trial

ObjectiveThe aim of this study was to assess the effects of Nigella sativa consumption on inflammatory biomarkers in patients with Non-alcoholic fatty liver disease (NAFLD).MethodsThis is a randomized, double-blind, placebo-controlled clinical trial. Fifty NAFLD patients were assigned to receive either two gram/day Nigella sativa seed as Nigella sativa group (NSG), or two gram/day starch as placebo group (PG) for 12 weeks.ResultsAt the end of the study, the serum levels of tumor necrosis factor-α (TNF-α) decreased significantly compared with the beginning of the study in both groups, while the levels of high sensitive C reactive protein (hs-CRP) and nuclear factor kappa-B (NF-κB) only decreased significantly in the NSG (P 0 < 0.05). Only reduction in the serum levels of TNF-α was significantly more in NSG compared to the PG (P = 0.001). After adjusting the effects of confounding factors, the results remained unchanged. According to Fibroscan exam, hepatic steatosis and its percentage decreased significantly only in the NSG (P 0 < 0.005); however, the changes were not significantly different between two groups. After adjusting for confounding factors, only steatosis percentage reduction was significantly more in the NSG compared to PG (P = 0.005).ConclusionOur results have shown that two gram/day consumption of Nigella sativa can reduce inflammatory biomarkers in patients with NAFLD. Further studies with different doses are highly recommended to find the optimal dosage.     

The effects of statin therapy on inflammatory cytokines in patients with bacterial infections: a randomized double-blind placebo controlled clinical trial

Objective  To determine if statin therapy reduces the incidence of severe sepsis and the levels of inflammatory cytokines in patients with acute bacterial infection. Design  Double-blind placebo controlled randomized clinical trial. Setting  Department of medicine and medical intensive care unit in a tertiary university medical center. Patients and participants  A total of 83 patients with suspected or documented bacterial infection were enrolled. We randomly assigned 42 patients to receive 40 mg of simvastatin orally, followed by 20 mg of simvastatin, and 41 to receive matching placebo. Measurements and results  The study was prematurely terminated due to slow recruitment rate. Here we report the analysis of the secondary outcome: change in cytokines levels at 72 h. Both groups were evenly matched in terms of co-morbidity and severity of illness on admission. Four of the 83 patients enrolled developed severe sepsis, two in each group. No difference was observed in other clinical variables and there were no mortalities. Cytokine levels were randomly assessed in 40 patients (20 in each group). Both TNF-α and IL-6 levels were significantly reduced in the simvastatin group (p = 0.02 and p = 0.02, respectively), while no such difference was observed in the placebo group (p = 0.35 and 0.39, respectively). Conclusions  Statin therapy may be associated with a reduction in the levels of inflammatory cytokines in patients with acute bacterial infections. Large controlled trials will determine if this reduction will translate into a clinical benefit. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

The effect of melatonin supplementation on liver indices in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized clinical trials

Several randomized clinical trials (RCTs) evaluated the effect of melatonin supplementation on liver enzymes in patients with non-alcoholic fatty liver disease (NAFLD) and reported conflicting results. To meet these discrepancies, a meta-analysis was conducted to evaluate the eff ;ect of melatonin on liver indices in patients with NAFLD. To collect the required data, a thorough search was conducted through Web of science, Pubmed, Cochrane database, Embase, Google Scholar, ProQuest, and Scopus databases. The aim was to find clinical trials over the effect of melatonin supplementation on liver indices up to 16 May 2019. As a result, five eligible articles were selected and analysed in this meta-analysis using a fixed-effects model. Heterogeneity test was performed by I² statistics and Cochrane Q test. The results showed that melatonin had a significant effect on aspartate aminoteransferase (AST) (WMD = 2.29, [95 %CI: 1.14, 3.43] IU/L, p = <0.001), alkaline phosphatase (ALP) (WMD = −8.40, [95 %CI −11.33, −5.48] IU/L, p < 0.001), and gamma-glutamyltransferase (GGT) (WMD = −33.37, [95 %CI: −37.24, −29.49] IU/L, p= < 0.001). Melatonin had no significant effect on alanine aminotransferase (ALT) regarding the overall effect size. Based on this meta-analysis, melatonin supplementation can improve liver indices. However, more RCTs are required with larger sample sizes and better control of confounding variables such as weight, body mass index, and gender to determine the effect of melatonin on patients with non-alcoholic fatty acid disease.     

Effects of curcumin on serum cytokine concentrations in subjects with metabolic syndrome: A post-hoc analysis of a randomized controlled trial

BackgroundCytokines are involved in the development of metabolic abnormalities that may result in metabolic syndrome (MetS). Since curcumin has shown anti-inflammatory properties, the aim of this study was to evaluate the effect of curcumin supplementation on serum cytokines concentrations in subjects with MetS.MethodsThis study was a post-hoc analysis of a randomized controlled trial in which males and females with diagnosis of MetS, according to the criteria defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines, were studied. Subjects who met the inclusion criteria were randomly assigned to either curcumin (daily dose of 1 g/day) or a matched placebo for a period of 8 weeks.ResultsOne hundred and seventeen subjects were assigned to either curcumin (n = 59) or placebo (n = 58) groups. Within-group analysis revealed significant reductions in serum concentrations of TNF-α, IL-6, TGF-β and MCP-1 following curcumin supplementation (p < 0.001). In the placebo group, serum levels of TGF-β were decreased (p = 0.003) but those of IL-6 (p = 0.735), TNF-α (p = 0.138) and MCP-1 (p = 0.832) remained unaltered by the end of study. Between-group comparison suggested significantly greater reductions in serum concentrations of TNF-α, IL-6, TGF-β and MCP-1 in the curcumin versus placebo group (p < 0.001). Apart from IL-6, changes in other parameters remained statistically significant after adjustment for potential confounders including changes in serum lipids and glucose levels, and baseline serum concentration of the cytokines.ConclusionResults of the present study suggest that curcumin supplementation significantly decreases serum concentrations of pro-inflammatory cytokines in subjects with MetS.     

Effect of soy milk consumption on glycemic status,blood pressure,fibrinogen and malondialdehyde in patients with non-alcoholic fatty liver disease: a randomized controlled trial

ObjectiveDiet plays a critical role in the management of non-alcoholic fatty liver disease (NAFLD). Studies on the NAFLD's experimental models have reported that soy had positive effects on the improvement of metabolic parameters. However, there is a lack of clinical trials regarding the efficacy of whole soy foods. Therefore, this study was conducted to determine the effect of soy milk on some of the metabolic characteristics in patients with NAFLD.MethodsSixty-sex patients diagnosed with NAFLD were included in this randomized, parallel, controlled trial and were randomly assigned to either the soy milk or control group. Both groups received a 500-deficit calorie diet plan. Also, patients in the soy milk group consumed 240 ml/day soy milk for 8 weeks. Fasting blood sugar (FBS), serum insulin, HOMA-IR, HOMA-β%, and QUICKI as well as serum malondialdehyde (MDA), plasma fibrinogen, and blood pressure (BP) were measured at the beginning and end of the study.ResultsAfter 8-weeks of intervention, soy milk group had a greater significant reduction in serum insulin(-3.44 ± 5.02 vs. -1.09 ± 3.77 μIU/ml, P = 0.04), HOMA-IR (-0.45±0.64 vs -0.14 ± 0.47, P = 0.03), systolic (-3.81±4.15 vs -1.48±2.93 mmHg, P = 0.01) and diastolic (-2.39±2.80 vs. -0.94±2.76 mmHg, P = 0.04) BP, and also, a significant increase in QUICKI (0.02± 0.032 vs. 0.008±0.018, P = 0.04) compared to the control group. While, changes in the FBS, HOMA-β%, fibrinogen, and MDA were not significantly different between the study groups.ConclusionA low-calorie diet containing soy milk had beneficial effects on serum insulin, HOMA-IR, QUICKI, and BP in patients with NAFLD.     

Comparison of delta-tocotrienol and alpha-tocopherol effects on hepatic steatosis and inflammatory biomarkers in patients with non-alcoholic fatty liver disease: A randomized double-blind active-controlled trial

ObjectiveWe aimed to compare the efficacy of δ-tocotrienol with α-tocopherol in the treatment of patients with non-alcoholic fatty liver disease (NAFLD).Design and interventionsThis study was a double-blinded, active-controlled trial. The patients with NAFLD were randomly assigned to receive either δ-tocotrienol 300 mg or α-tocopherol 268 mg twice daily for 48 weeks.EndpointsThe primary endpoints were change from baseline in fatty liver index (FLI), liver-to-spleen attenuation ratio (L/S ratio), and homeostatic model assessment for insulin resistance (HOMA-IR) at 48 weeks. Key secondary endpoints were change in markers of inflammation, oxidative stress, and hepatocyte apoptosis. Clinical assessment, biochemical analysis, and computed tomography scan of the liver were conducted at baseline, 24 and 48 weeks.ResultsA total of 100 patients (δ-tocotrienol = 50, α-tocopherol = 50) were randomized and included in the intention to treat analysis. Compared with baseline, there was a significant improvement (p < .001) in FLI, L/S ratio, HOMA-IR, and serum malondialdehyde in both groups at 48 weeks that was not significant between the two groups. However, there was a significantly greater decrease in body weight, serum interleukin-6, tumor necrosis factor-alpha, leptin, cytokeratin-18, and increase in adiponectin in the δ-tocotrienol group compared to the α-tocopherol group at 48 weeks (p < .05). No adverse events were reported.Conclusionδ-tocotrienol and α-tocopherol exerted equally beneficial effects in terms of improvement in hepatic steatosis, oxidative stress, and insulin resistance in patients with NAFLD. However, δ-tocotrienol was more potent than α-tocopherol in reducing body weight, inflammation, and apoptosis associated with NAFLD.Trial RegistrationSri Lankan Clinical Trials Registry (https://slctr.lk/SLCTR/2019/038).     

Effects of garlic powder supplementation on insulin resistance,oxidative stress,and body composition in patients with non-alcoholic fatty liver disease: A randomized controlled clinical trial

BackgroundNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Insulin resistance, oxidative stress, and obesity are major contributors to NAFLD pathogenesis. The effects of garlic powder supplementation on these risk factors in patients with NAFLD was investigated.MethodsIn this 12-wk, randomized controlled clinical trial, ninety patients with NAFLD were randomly assigned to two groups. The treatment group received four tablets of garlic (each coated tablet contained 400 mg garlic powder) daily and the control group received four tablets of placebo (each coated tablet contained 400 mg starch).ResultsA significant decrease was seen in the treatment group compared to the control group in waist circumference (P = 0.001), body fat percent (P < 0.001), serum concentration of fasting blood sugar (P = 0.01), insulin (P < 0.001), homeostatic model assessment for insulin resistance (P < 0.001), and malondialdehyde (P < 0.001), as well as significant increase in skeletal muscle mass (P = 0.002), serum concentration of superoxide dismutase (P < 0.001), and total antioxidant capacity (P < 0.001).ConclusionGarlic powder supplementation improved risk factors of NAFLD. Further studies are needed to determine the effects of garlic on hepatic features in patients with NAFLD. The study protocol was registered at Iranian clinical trials website under code IRCT20170206032417N4.     

Delta-tocotrienol supplementation improves biochemical markers of hepatocellular injury and steatosis in patients with nonalcoholic fatty liver disease: A randomized,placebo-controlled trial

ObjectiveThe aim of this study was to examine the effects of delta-tocotrienol (δ-tocotrienol) supplementation on biochemical markers of hepatocellular injury and steatosis in patients with nonalcoholic fatty liver disease (NAFLD).DesignThe study design was a two-group, randomized, double-blind, placebo-controlled trial. The patients with NAFLD were randomly assigned to receive δ-tocotrienol 300 mg twice daily or placebo for 24 weeks.EndpointsThe primary endpoints were change from baseline in fatty liver index (FLI) and homeostasis model of insulin resistance (HOMA-IR) after 24 weeks. Secondary endpoints included change from baseline in high sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), alanine transaminase (ALT), aspartate transaminase (AST) and grading of hepatic steatosis on ultrasound. Between-group differences were tested for significance using ANCOVA. Mean differences (MD) with 95 % CIs are reported.ResultsA total of 71 patients (tocotrienol=35, placebo=36) were randomized and included in the intention to treat analysis. Compared with placebo, δ-tocotrienol significantly reduced (MD [95 % CI]) FLI (−8.52 [−10.7, −6.3]; p < 0.001); HOMA-IR (−0.37 [−0.53, −0.21]; p < 0.001), hs-CRP (−0.61[−0.81, −0.42]; p < 0.001), MDA (−0.91 [−1.20, −0.63]; p < 0.001), ALT (−8.86 [−11.5, −6.2]; p < 0.001) and AST (−6.6 [−10.0, −3.08]; p < 0.001). Hepatic steatosis was also reduced by a significantly greater extent with tocotrienol than with placebo (p =0.047). No adverse events were reported.Conclusionδ-tocotrienol effectively improved biochemical markers of hepatocellular injury and steatosis in patients with NAFLD. δ-tocotrienol supplementation might be considered as a therapeutic option in the management of patients with NAFLD.Trial RegistrationSri Lankan Clinical Trials Registry (SLCTR/2015/023, 2015-10-03).     

Effect of green coffee extract supplementation on serum adiponectin concentration and lipid profile in patients with non-alcoholic fatty liver disease: A randomized,controlled trial

ObjectivesThe current study evaluated the effects of green coffee extract (GCE) on serum lipid profile and adiponectin levels in patients with nonalcoholic fatty liver disease (NAFLD).DesignThis randomized, double-blind, placebo-controlled clinical trial was conducted on NAFLD patients aged 20–60 years and body mass index (BMI) of 25−35 kg/m².SettingPatients were recruited from the Bahman poly-clinic (Neyshabur, Iran) between January and June 2016.InterventionsThe study subjects were randomly assigned to receive a daily dose of 400 mg GCE (n = 24) or placebo (n = 24) for eight weeks.Main outcome measuresSerum liver enzyme levels, lipid profile, adiponectin concentrations, and hepatic steatosis grade were measured for all patients at baseline and the end of the trial.ResultsGCE supplementation significantly reduced BMI [mean difference (MD): −0.57 and 95 % confidence interval (CI): −0.84 to −0.29, P < 0.001] and increased serum high-density lipoprotein cholesterol (MD: 7.06, 95 % CI: 0.25–13.87, P < 0.05) compared to the control group. Serum total cholesterol decreased significantly within the GCE group (MD: −13.33, 95 % CI: −26.04 to −0.61, P < 0.05). Triglyceride levels reduced significantly in GCE group compared to the placebo group (MD: -37.91; 95 % CI: −72.03 to −3.80; P = 0.03). However, this reduction was not significant when was further adjusted for mean changes in BMI and daily energy intake (MD: -23.43; 95 % CI: −70.92 to 24.06; P = 0.32). Hepatic steatosis grade, liver enzymes, and adiponectin levels did not show significant differences between the two groups after the intervention.ConclusionsGCE supplementation improved serum lipid profile and BMI in individuals with NAFLD. GCE may be useful in controlling NAFLD risk factors.     

The effect of melatonin on treatment of patients with non-alcoholic fatty liver disease: a randomized double blind clinical trial

ObjectivesMany factors implicated in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) are including oxidative stress, insulin resistance and abnormal production of adipokines. The aim of this clinical trial was to evaluate the effect of melatonin supplement on some important biochemical markers and signs related to NAFLD.DesignA randomized double-blind, placebo-controlled, clinical trial.SettingTwenty-four participants in the melatonin group and 21 participants in the placebo group completed the study.InterventionParticipants received 6 mg melatonin or placebo daily, 1 h before bedtime. The intervention period was 12 weeks.Main outcome measuresAnthropometric measurements, systolic and diastolic blood pressure, liver enzymes, high sensitive C‑reactive protein (hs-CRP), fatty liver grade, also leptin and adiponectin serum levels, were measured at the baseline and the end of intervention.ResultsA significant improvement was observed in weight (p = 0.043), waist circumference (p = 0.027), abdominal circumference (p = 0.043), systolic (p = 0.039), and diastolic (p = 0.015) blood pressure, leptin serum levels (p = 0.032), hs-CRP (p = 0.024), alanine aminotransferase (p = 0.011), aspartate aminotransferase (p = 0.034), also the grade of fatty liver (p = 0.020) in melatonin treated group compared with the placebo.ConclusionsAdministration of 6 mg/day melatonin had improvement effect on many factors related to NAFLD such as liver enzymes, hs-CRP, anthropometric measurements, blood pressure, leptin serum levels and the grade of fatty liver.     

GLP-1改善非酒精性脂肪肝病作用机制的研究进展

非酒精性脂肪肝病与肥胖、胰岛素抵抗、2型糖尿病和血脂紊乱等密切相关。随着肥胖和糖尿病的发病率逐渐增加,非酒精性脂肪肝病已成为全球最常见的慢性肝脏疾病。目前,NAFLD的治疗主要是改善生活方式、减轻体重和降脂药物的应用,尚缺乏特效的药物治疗。GLP-1主要用于糖尿病和减重治疗,但最近大量临床和临床前研究表明GLP-1可通过多种 机制减轻NAFLD。本文将GLP-1改善NAFLD的相关机制综述如下,进一步加深我们对GLP-1改善NAFLD分子机制的理解。     

Curcumin as adjuvant treatment in patients with non-alcoholic fatty liver (NAFLD) disease: A systematic review and meta-analysis

ObjectiveThe aim of this review is to determine the effect of curcumin on the liver ultrasonographic morphology, and the effectiveness of curcumin as adjuvant treatment for NAFLD.MethodsThe Cochrane library and PubMed were searched systematically to identify randomized controlled trials from 2000 to January 2021. The primary outcomes were NAFLD severity, liver steatosis resolution, liver scarring, liver enzymes, also lipid profiles. 16 RCTs with a total of 1028 participants were included in the meta-analysis.ResultsCurcumin improved NAFLD severity (RR: 3.52, 95 % CI 1.27–9.72; P = 0.02) and increased the liver steatosis resolution (RR 3.96, 95 % CI 1.54–10.17; P = 0.004) based on the liver ultrasonographic finding. Curcumin supplementation reduced aspartate aminotransferase (MD − 4.00, 95 % CI − 5.72 to − 2.28; P < 0.001), alanine aminotransferase (MD − 7.02, 95 % CI − 9.83 to − 4.20; P < 0.001), total cholesterol (MD − 11.86, 95 % CI − 19.25 to − 4.46; P = 0.002) and BMI (MD: − 0.41, 95 % CI − 0.75 to − 0.07; P = 0.02).ConclusionCurcumin supplementation has a favorable effect on liver ultrasonographic findings, reduced serum liver enzymes, total cholesterol, and BMI in participants with NAFLD. Therefore, promoting curcumin as adjuvant treatment on NAFLD patients might be justified.     

Pharmaconutrition strategy to resolve SARS-CoV-2-induced inflammatory cytokine storm in non-alcoholic fatty liver disease: Omega-3 long-chain polyunsaturated fatty acids

Inflammation is one of the primary factors associated with the causation and/or progression of several lifestyle disorders, including obesity, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). NAFLD is a spectrum of disorders, and starts with simple steatosis, progresses to non-alcoholic steatohepatitis, and then advances to fibrosis, cirrhosis and finally, hepatocellular carcinoma, due to perpetual cycles of insults caused by inflammation and other cellular stress. Emerging evidence has documented that patients with NAFLD have severe coronavirus disease 2019 (COVID-19), and patients with COVID-19 have a higher liver injury and mortality. Although the exact cause or mechanism is not known, inflammatory cytokine storm is a characteristic feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and is known to be associated with higher mortality among COVID-19 patients. Therefore, the COVID-19 pandemic seems to be a major concern in NAFLD patients, who have contracted SARS-CoV-2 infection and develop COVID-19. This is evident in patients at any stage of the NAFLD spectrum, as the inflammatory cytokine storm may cause and/or aggravate the progression or severity of NAFLD. Thus, there is a need for resolution of the inflammatory cytokine storm in these patients. A large body of evidence has demonstrated the efficacy of omega-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA) in NAFLD conditions, due to their anti-inflammatory, immunomodulatory and anti-viral properties. Therefore, intervention with ω-3 LCPUFA, an effective pharmaconutrient along with the standard treatment for COVID-19 may be useful in the management of the NAFLD spectrum in COVID-19 patients with pre-existing NAFLD conditions by resolving the inflammatory cytokine storm and thereby attenuating its progression. Although there are challenges in implementation, optimistically they can be circumvented and the pharmaconutrition strategy may be potentially helpful in tackling both the pandemics; NAFLD and COVID-19 at least in this subset of patients.     

The effects of carnitine supplementation on clinical characteristics of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThe beneficial effects of carnitine supplementation on nonalcoholic fatty liver disease are unclear. We conducted a systematic review and meta-analysis to evaluate the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance in patients with nonalcoholic fatty liver disease.MethodsA comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were performed. Only randomized placebo-controlled human studies that examined the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance up to September 2019 were included. Fixed effects or random-effects models were applied to compute the pooled effect size. Heterogeneity assessments were performed using Cochran’s Q test and I-squared statistics. The quality of the studies was assessed using the Jaded scale.ResultsA total of 5 articles were selected, including 334 individuals (167 in control and 167 in intervention groups). The results demonstrated that carnitine supplementation significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: −0.91; 95 % CI: −1.11, −0.72; p < 0.001, I² = 0.0 %) and the levels of aspartate aminotransferase (AST) (WMD: −16.62; 95 % CI: −28.11, −5.14; IU/l; p = 0.005, I² = 93.5 %), alanine aminotransferase (ALT) (WMD: -33.39; 95 % CI: −45.13, −21.66; IU/l; p < 0.001, I² = 93.4 %), and triglycerides (TG) (WMD: −22.13; 95 % CI: −38.91, −5.34; mg/dl; p = 0.01; I² = 0.0 %). However, the results of the pooled effect size did not show any significant effect of carnitine supplementation on body mass index (BMI) (WMD: 0.07; 95 % CI: −0.15, 0.29; p = 0.55; I² = 0.0 %), body weight (WMD: −0.28; 95 % CI: −2.23, 1.68; p = 0.78; I² = 45.7 %), the levels of gamma-glutamyl transferase (γGT) (WMD: −11.31; 95 % CI: −24.35, 1.73; IU/l; p = 0.09, I² = 61.1 %), cholesterol (WMD: −13.58; 95 % CI: −46.77, 19.60; mg/dl; p = 0.42; I² = 94.9 %), high-density lipoprotein-cholesterol (HDL-C) (WMD: 1.36; 95 % CI: −0.96, 3.68; mg/dl; p = 0.25; I² = 64.7 %), and low density lipoprotein-cholesterol (LDL-C) (WMD: −14.85; 95 % CI: −45.43, 15.73; mg/dl; p = 0.34; I² = 96.4 %).ConclusionsThis analysis shows that carnitine supplementation for patients with nonalcoholic fatty liver disease demonstrates a reduction in AST, ALT, TG levels and HOMA-IR. However, no significant effect of carnitine supplementation was observed on BMI, body weight, the levels of γGT, TC, HDL-cholesterol and LDL-cholesterol.     

非酒精性脂肪性肝病患者炎症因子及内皮功能变化及意义

目的 探讨非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者炎症因子及内皮功能的变化及意义.方法 55例NAFLD患者(NAFLD组)和34例体检健康者(对照组),检测2组谷丙转氨酶(glutamic-pyruvic transaminase,GPT)、谷草转氨酶(glutamic-oxaloacetic transaminase,GOT)、内皮素-1(endothelin 1,ET-1)、高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、一氧化氮(nitrogen monoxide,NO)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)水平;并行超声检查,观察2组肱动脉血流介导的内皮依赖性舒张(flow mediated vasodilation,FMD)功能;逐步线性回归分析FMD与各指标的相关性.结果 NAFLD组TNF-α、IL-6、hs-CRP、HOMA-IR及ET-1分别为(32.56±6.40) ng/L、(38.87±3.89)ng/L、(18.19±5.66)mg/L、4.69±2.16、(239.53±15.69) ng/L),均高于对照组((9.38±3.12) ng/L、(7.54±2.38)ng/L、(5.56±3.07) mg/L、0.89±0.22、(50.34±10.78)ng/L) (P＜0.05),FMD((7.86±1.07)％)、NO((27.28±8.42)μmol/L)低于对照组((12.70±2.68)％、(63.24±10.23) μmol/L) (P＜0.05);逐步线性回归分析显示,FMD水平与hs-CRP(r=-0.462,P=0.008)、NAFLD(r=-0.528,P=0.045)、HOMA-IR(r=-0.324,P=0.018)呈负相关.结论 NAFLD与炎症、血管内皮功能障碍密切相关,NAFLD患者需及时进行血管内皮功能障碍干预,预防动脉粥样硬化发生.     

Dietary phytochemical index and the risk of non-alcoholic fatty liver disease: A case-control study among Iranian adults

BackgroundsDietary phytochemical index (DPI) is an inexpensive method for estimating the amounts of phytochemicals in foods. No study has investigated the association between DPI and non-alcoholic fatty liver disease (NAFLD). Our study aimed to compare DPI in patients with NAFLD and the control group.MethodsThis is a case-control study of 250 subjects with NAFLD and 450 healthy subjects attending the Metabolic Liver Disease Research Center as a referral center affiliated to Isfahan University of Medical Sciences. DPI was calculated based on data collected from a 168-item validated food frequency questionnaire. Sociodemographic data, physical activity, and anthropometric measures such as body weight, height, and waist circumference were determined.ResultsIn the final adjusted model, the odds ratio (OR) of NAFLD across the DPI tertiles decreased significantly (OR = 0.55, 95 %CI = 0.31–0.95) (P-trend = 0.03). The highest vs. lowest tertiles of vegetable and olives PI were significantly associated with a lower risk of NAFLD (OR and 95 % CI = 0.26 (0.14–0.47); OR and 95 % CI = 0.51 (0.29–0.90), p for trend < 0.001, respectively), however, there was no significant relation between other PI components and NAFLD.ConclusionThis case-control study suggested that a higher PI score is associated with a reduced chance of NAFLD after adjusting for confounding variables. In addition, the highest tertile of vegetable and olives PI was significantly associated with a lower risk of NAFLD.     

Portal vein hemodynamics in patients with non-alcoholic fatty liver disease

Paralleling the rise in the incidence of obesity and diabetes worldwide, nonalcoholic fatty liver disease (NAFLD) is being increasingly recognized as one of the major causes of chronic liver disease. Doppler sonography is used as a diagnostic method in the non-invasive assessment of the hemodynamics of hepatic vascular flow in liver diseases. We investigated the effects of fatty infiltration in the liver on the Doppler flow hemodynamics of the portal vein. Doppler sonography of the liver and portal vein was performed in 60 subjects with NAFLD and 20 healthy volunteers (control). The patients were grouped into mild (grade 1), moderate (grade 2), and severe (grade 3) according to sonographic appearance of hepatosteatosis (n = 20 for each group). The vein pulsatility index (VPI), mean flow velocity (MFV), peak maximum velocity (V(max)), and peak minimum velocity (V(min)) of the portal vein were significantly lower in patients with NAFLD than those of the controls (p < 0.001). The VPI was 0.20 in the patients and 0.31 in the control. The MFV was 12.3 cm/sec in the patients and 16.5 cm/sec in the control group. The portal vein flow was found to be decreased as the grade of fatty infiltration increased for VPI (r = -0.946, p < 0.001), MFV (r = -0.951, p < 0.001). The alteration in Doppler waveform pattern of portal vein with fatty liver population suggests reduced vascular compliance in the liver.     

CK18-M30和内毒素在大鼠非酒精性脂肪肝病中的促进作用

目的探讨细胞角蛋白18-M30片段(CK18-M30)、内毒素在大鼠非酒精性脂肪肝病(NAFLD)转化为非酒精性脂肪性肝炎(NASH)中的促进作用。方法 26只大鼠随机分为3组,对照组(NC组):普通饮食;NAFLD组:高脂饮食喂养8周;NASH组:高脂饮食喂养12周。生化仪测定血清谷丙转氨酶(ALT)、谷草转氨酶(AST);光度法测定血清内毒素(ET);ELISA检测血清IL-18、CK18-M30,RT-PCR分析粪便肠道菌群;行苏木精伊红(HE)染色观察肝脏及末端回肠组织病理。结果 NAFLD及NASH组相比NC组,小肠黏膜结构由轻到重受到破坏。NAFLD组及NASH组大鼠血清ET、CK18-M30、肝脂肪变性程度及NAFLD活动度积分(NAS)、大肠杆菌属计数显著高于NC组,而双歧杆菌属、乳酸杆菌属计数显著低于NC组,差异有统计学意义(P<0.05);NASH组大鼠血清ET、CK18-M30、肝脂肪变性程度及NAS显著高于NAFLD组,差异有统计学意义(P<0.05);NASH组大鼠血清ALT、AST、IL-18显著高于NC组及NAFLD组,差异有统计学意义(P&l...     

Effects of curcumin supplementation on inflammatory biomarkers in patients with Rheumatoid Arthritis and Ulcerative colitis: A systematic review and meta-analysis

BackgroundAlthough previous studies have examined the impact of curcumin supplementation on cytokine levels in patients with autoimmune disorders, we were unable to find a systematic review of the effect of curcumin supplementation on inflammatory biomarkers such as CRP and ESR in patients with rheumatoid arthritis or ulcerative colitis; therefore we conducted this systematic review and meta-analysis.MethodsRelevant studies published from inception to December 2020 were systematically searched through the PubMed, SCOPUS, and google scholar databases. We conducted our systematic review and meta-analysis according to the 2020 PRISMA guidelines. The quality of the papers were assessed by using the Cochrane Collaboration's risk of bias tool. Included studies were randomized clinical trials on the effects of supplementation with curcumin or its derivative on inflammatory factors in patients with rheumatoid arthritis and ulcerative colitis. Pooled effect sizes were calculated using a random-effects model and reported as the weighted mean difference (WMD) and 95 % CI.ResultsIn all, six studies met the inclusion criteria for this study. Curcumin supplementation in doses of 250−1500 mg/day over 8–12 weeks was observed to be associated with decreases in CRP and ESR in adult patients with rheumatoid arthritis and ulcerative colitis in comparison with the control group (WMD: −0.42; 95 % CI: −0.59, −0.26, I² = 94.3 %; WMD: −55.96; 95 % CI: −93.74, −18.17, I² = 99.7 %, respectively). Significant findings were also observed based on subgroup analyses by the study sample size, duration, participants’ age, curcumin dosage, and type of disease.ConclusionsCurcumin supplementation was associated with significant reductions in levels of CRP and ESR in patients with rheumatoid arthritis and ulcerative colitis. Earlier studies reported curcumin as a safe complementary therapy for several diseases. However, a handful of studies were found on the effect of curcumin on autoimmune diseases despite our comprehensive search. Further studies are therefore warranted in this area.