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      The additive effect of herbal medicines on lifestyle modification in the treatment of non-alcoholic fatty liver disease: a systematic review and meta-analysis

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          Abstract

          Introduction: 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.

          Methods: 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.

          Results and Discussion: 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, p < 0.1). In addition, herbal medicines decreased the levels of aspartate transferase (MD -7.5, 95% CI -13.4 to −1.7, p = 0.01) and total cholesterol (MD -16.0, 95% CI -32.7 to 0.7, p = 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.

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          Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention

          Zobair Younossi, Quentin M Anstee, Milena Marietti … (2018)
          NAFLD is one of the most important causes of liver disease worldwide and will probably emerge as the leading cause of end-stage liver disease in the coming decades, with the disease affecting both adults and children. The epidemiology and demographic characteristics of NAFLD vary worldwide, usually parallel to the prevalence of obesity, but a substantial proportion of patients are lean. The large number of patients with NAFLD with potential for progressive liver disease creates challenges for screening, as the diagnosis of NASH necessitates invasive liver biopsy. Furthermore, individuals with NAFLD have a high frequency of metabolic comorbidities and could place a growing strain on health-care systems from their need for management. While awaiting the development effective therapies, this disease warrants the attention of primary care physicians, specialists and health policy makers.
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            Mechanisms of NAFLD development and therapeutic strategies

            Mary Rinella, Arun Sanyal, Scott Friedman … (2018)
            There has been a rise in the prevalence of nonalcoholic fatty liver disease (NAFLD), paralleling a worldwide increase in diabetes and metabolic syndrome. NAFLD, a continuum of liver abnormalities from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), has a variable course but can lead to cirrhosis and liver cancer. Here we review the pathogenic and clinical features of NAFLD, its major comorbidities, clinical progression and risk of complications and in vitro and animal models of NAFLD enabling refinement of therapeutic targets that can accelerate drug development. We also discuss evolving principles of clinical trial design to evaluate drug efficacy and the emerging targets for drug development that involve either single agents or combination therapies intended to arrest or reverse disease progression.
            Article 0 comments Cited 1347 times – based on 0 reviews     Review now
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              The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis

              Kiarash Riazi, Hassan Azhari, Jacob H. Charette … (2022)
              Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and the leading cause of liver-related morbidity and mortality. We aimed to predict the burden of NAFLD by examining and estimating the temporal trends of its worldwide prevalence and incidence.
              Article 0 comments Cited 443 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Myung-Ho Kim: URI : https://loop.frontiersin.org/people/2093468/overviewRole: Role:
                Subin Ahn: Role: Role:
                Nayeon Hur: Role: Role:
                Seung-Yun Oh: Role: Role:
                Chang-Gue Son: URI : https://loop.frontiersin.org/people/558028/overviewRole: Role:
                Journal
                Journal ID (nlm-ta): Front Pharmacol
                Journal ID (iso-abbrev): Front Pharmacol
                Journal ID (publisher-id): Front. Pharmacol.
                Title: Frontiers in Pharmacology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1663-9812
                Publication date (Electronic): 23 February 2024
                Publication date Collection: 2024
                Volume: 15
                Electronic Location Identifier: 1362391
                Affiliations
                [1] 1 Liver and Immunology Research Center , Daejeon Korean Medicine Hospital of Daejeon University , Daejeon, Republic of Korea
                [2] 2 Department of Internal Korean Medicine , Woosuk University Medical Center , Jeonju, Republic of Korea
                [3] 3 Department of Sasang Constitutional Medicine , Woosuk University Medical Center , Jeonju, Republic of Korea
                Author notes

                Edited by: Rongrui Wei, Jiangxi University of Traditional Chinese Medicine, China

                Reviewed by: Allah Nawaz, Joslin Diabetes Center and Harvard Medical School, United States

                Ishtiaq Jeelani, University of California, San Diego, United States

                *Correspondence: Myung-Ho Kim, check8x8@ 123456woosuk.ac.kr ; Chang-Gue Son, ckson@ 123456dju.kr
                Article
                Publisher ID: 1362391
                DOI: 10.3389/fphar.2024.1362391
                PMC ID: 10920213
                PubMed ID: 38464716
                SO-VID: 90ec0a46-6b08-4f79-bccc-a225ed062c40
                Copyright © Copyright © 2024 Kim, Ahn, Hur, Oh and Son.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 28 December 2023
                Date accepted : 12 February 2024
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Woosuk University, a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), and funded by the Ministry of Health and Welfare, Republic of Korea (Grant No. HF23C0074).
                Categories
                Subject: Pharmacology
                Subject: Systematic Review
                Custom metadata
                section-at-acceptance Ethnopharmacology

                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: non-alcoholic fatty liver disease,herbal medicine,lifestyle modification,systematic review,meta-analysis
                Data availability:
                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: non-alcoholic fatty liver disease, herbal medicine, lifestyle modification, systematic review, meta-analysis

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