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Efficacy of artichoke leaf extract in non-alcoholic fatty liver disease: A pilot double-blind randomized controlled trial
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and is potentially treatable, though there are few therapeutic agents available. Artichoke leaf extract (ALE) has shown potential as a hepatoprotective agent. This study sought to determine if ALE had therapeutic utility in patients with established NAFLD. In this randomized double-blind placebo-controlled parallel-group trial, 100 subjects with ultrasound-diagnosed NAFLD were randomized to either ALE 600 mg daily or placebo for a 2-month period. NAFLD response was assessed by liver ultrasound and serological markers including the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio and AST to platelet ratio index (APRI) score. Ninety patients completed the study (49 ALE and 41 placebo) with no side effects reported. ALE treatment compared with placebo: Doppler sonography showed increased hepatic vein flow (p < .001), reduced portal vein diameter (p < .001) and liver size (p < .001), reduction in serum ALT (p < .001) and AST (p < .001) levels, improvement in AST/ALT ratio and APRI scores (p < .01), and reduction in total bilirubin. ALE supplementation reduced total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and triglyceride concentrations (p = .01). This study has shown beneficial effects of ALE supplementation on both ultrasound liver parameters and liver serum parameters (ALT, AST, APRI ratio, and total bilirubin) in patients with NAFLD.
... Artichoke leaf 's antioxidant properties and characteristic lipid-lowering and hepatoprotective activities have been attributed to mono-and dicaffeoylquinic acids (cynarin and chlorogenic acid), caffeic acid, sesquiterpene lactones, and flavonoids (including the glycosides luteolin-7-O-rutinoside, luteolin-7-O-glucoside, and luteolin-4-O-glucoside). [64][65][66] Other constituents in the phytochemical profile include phytosterols, tannins, glycolic and glyceric acids, sugars, inulins, and enzymes. 67 The natural bitter taste of artichoke leaf is attributed to cynaropicrin, a sesquiterpene lactone. ...
... Currently, inulin is researched for its benefits as a prebiotic, which may promote beneficial bacteria found in the gastrointestinal system. 69,70 Specifically, recent human clinical trials of artichoke preparations have documented health benefits associated with artichoke's lipid-lowering effects, 71-74 hepatoprotective effects, 64 and improvement of gastrointestinal symptoms related to functional dyspepsia 75,76 and irritable bowel syndrome (IBS). 77,78 64 Pilot, DB-RCT, PC, parallel-group, N = 100, adults with ultrasounddiagnosed nonalcoholic fatty liver disease (NAFLD) ...
... 69,70 Specifically, recent human clinical trials of artichoke preparations have documented health benefits associated with artichoke's lipid-lowering effects, 71-74 hepatoprotective effects, 64 and improvement of gastrointestinal symptoms related to functional dyspepsia 75,76 and irritable bowel syndrome (IBS). 77,78 64 Pilot, DB-RCT, PC, parallel-group, N = 100, adults with ultrasounddiagnosed nonalcoholic fatty liver disease (NAFLD) ...
... NAFLD is a public health problem with a high prevalence, directly impacting around 11-16% of the world population. This pathological syndrome is characterized by excessive Plants 2024, 13,1985 2 of 16 build-up of lipids in hepatocytes. The mechanism of this state is an imbalance between the input and output of free fatty acid metabolism in liver tissue [7]. ...
... Artichoke (Cynara cardunculus L.) is a plant widely consumed in the Mediterranean diet. Pharmacological effects are related to the presence of antioxidants, such as cynarin, chlorogenic acid, caffeic acid and its derivatives, and the volatile sesquiterpene and flavonoids, including the glycosides of luteolin [13]. The hepatoprotective mechanism is connected to cholesterol reduction, as artichoke is well known for decreasing the reactive oxygen species level, lipid peroxidation, protein oxidation, the oxidation of LDL-cholesterol, and causing an increase in glutathione peroxidase activity [14,15]. ...
... Plants 2024,13, 1985 ...
The hepatoprotective effects of natural products have been a significant focus in recent decades due to the growing demand for the help in the treatment of hepatic impairments. This review specifically delves into the findings of clinical trials involving 13 selected natural products, namely plants and their derived compounds (e.g., artichoke, berberine, and turmeric), algae (e.g., spirulina), probiotics, and other products like phospholipids and vitamin D. A literature search was performed in the Scopus database, PubMed, and Google Scholar, covering all articles found up to June 2024. Artichoke, berberine, chlorella, chicory, green tea, probiotics, phospholipids, schisandra, silymarin, spirulina, and vitamin D caused a decrease in liver enzymes, while for cinnamon and turmeric such an effect was either not observed or not convincing. The presented results indicate that some natural products might satisfactorily improve hepatic outcomes in NAFLD, NASH, and other liver disorders; however, further studies and metanalyses are needed to clearly demonstrate their effectiveness.
... Fourteen investigations with a total of 952 patients reported FBS results (Cicero et al., 2019a;Cicero et al., 2019b;Ebrahimi-Mameghani et al., 2018;Fallah Huseini et al., 2012;Ferro et al., 2020;Fogacci et al., 2022;Panahi et al., 2018;Rangboo et al., 2016;Rezazadeh et al., 2018;Riva et al., 2021;Rolnik & Olas, 2021;Rondanelli et al., 2011Rondanelli et al., , 2013Rondanelli et al., , 2014. The effects of artichoke on FBS were significantly different from those of the control group (WMD = −3.76, ...
... Twenty trials (Bundy et al., 2008;Castellino et al., 2019;Cicero et al., 2019a;Cicero et al., 2019b;Ebrahimi-Mameghani et al., 2018;Englisch et al., 2000;Fallah Huseini et al., 2012;Ferro et al., 2020;Fogacci et al., 2022;Lupattelli et al., 2004;Panahi et al., 2018;Rangboo et al., 2016;Rezazadeh et al., 2018;Riva et al., 2021;Roghani-Dehkordi & Kamkhah, 2009;Rondanelli et al., 2011Rondanelli et al., , 2013Rondanelli et al., , 2014Rondanelli et al., , 2020Skarpañska-Stejnborn et al., 2008) documented artichoke's clinical therapeutic effect on lipid profile. LDL levels in the artichoke-treated group were considerably lower than those in the placebo group (WMD −12.94 mg/dL; 95%CI −18.02, −7.87; p < 0.0001), with signs of heterogeneity across trials (I 2 = 90%, p < 0.00001) ( Figure 5). ...
... Eleven studies (Ardalani et al., 2020;Castellino et al., 2019;Cicero et al., 2019a;Cicero et al., 2019b;Ferro et al., 2020;Panahi et al., 2018;Rezazadeh et al., 2018;Riva et al., 2021;Roghani-Dehkordi & Kamkhah, 2009;Rondanelli et al., 2014Rondanelli et al., , 2011) with a total of 870 patients reported BW and BMI. The aggregated findings revealed that the impact of artichoke on BW differed significantly from that of the control group (WMD −1.17 kg; 95%CI −1.75, −0.60; p < 0.001). ...
Background
Artichoke ( Cynara scolymus L.) has the potential to treat diabetes, dyslipidemia, hypertension, and obesity. However, the evidence from previous studies is not consistent.
Objectives
This meta-analysis evaluated the efficacy of products derived from artichokes on blood glucose, lipid level, blood pressure, and anthropometric parameters.
Methodology
The literature was reviewed via international databases (PubMed, ScienceDirect, and Scopus). A total of 21 RCTs with high quality, assessed by the Cochrane risk-of-bias tool, were included.
Results
Artichoke was linked to a significant reduction in fasting blood sugar (FBS) (WMD: −3.76 mg/dL: 95%CI −7.31, −0.22), insulin level (WMD: −1.35 mIU/L: 95%CI −2.29, −0.41), and HOMA-IR (WMD: −1.00: 95%CI −1.95, −0.06). Similar results were observed for LDL-c (WMD: −12.94 mg/dL: 95%CI −18.02, −7.87), total cholesterol (TC) (WMD: −19.64 mg/dL: 95%CI −23.94, −15.35), and triglyceride (TG) (WMD: −13.36 mg/dL: 95%CI −19.06, −7.66). Moreover, participants who administered artichoke experienced a significant reduction in SBP (WMD: −1.59 mmHg: 95%CI −3.02, −0.16), body weight (BW) (WMD: −1.17 kg: 95%CI −1.75, −0.60), and BMI (WMD: −0.30 kg/m ² : 95%CI −3.02, −0.16).
Conclusion
Artichoke may improve blood glucose, lipid profile, blood pressure, and anthropometric parameters. A large, well-designed RCT and head-to-head comparison using a standardized preparation of artichoke will provide definitive data on specific participants.
... Artichoke can have protective effects against NAFLD by reducing the production of reactive oxygen species [13], lipid peroxidation [9], and protein oxidation and increasing the activity of glutathione peroxidase [14]. Some in vitro, animal, and human studies evaluated the potential antioxidant effect of artichoke on hepatocytes [15][16][17][18]. In a study conducted by Panahi et al. [17], treatment with artichoke leaf extract (ALE) significantly lowered aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and improved AST/ALT ratio compared with the placebo group. ...
... Some in vitro, animal, and human studies evaluated the potential antioxidant effect of artichoke on hepatocytes [15][16][17][18]. In a study conducted by Panahi et al. [17], treatment with artichoke leaf extract (ALE) significantly lowered aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and improved AST/ALT ratio compared with the placebo group. However, Fallah Huseini et al. [19] did not find any significant effects on ALT and AST for ALE group in comparison with the control group. ...
... The p values less than 0.05 were considered to be statistically significant. [27] 2000 L L L L L L 2. Roghani-Dehkordi and Kamkhah [30] 2009 L L L L L L 3. Fallah Huseini et al. [19] 2012 L L L L S L 4. Rangboo et al. [29] 2016 L L S L L L 5. Panahi et al. [17] 2018 L L L L L L 6. Musolino et a. [28] 2020 L L L L L L 7. Rondanelli et al. [31] 2020 L L L L L L L, Low risk of bias; H, High risk of bias; S, Some concerns. ...
Studies examining the effect of artichoke on liver enzymes have reported inconsistent results. This systematic review and meta-analysis aimed to assess the effects of artichoke administration on the liver enzymes. PubMed, Embase, the Cochrane Library, and Scopus databases were searched for articles published up to January 2022. Standardized mean difference (Hedges' g) were analyzed using a random-effects model. Heterogeneity, publication bias, and sensitivity analysis were assessed for the liver enzymes. Pooled analysis of seven randomized controlled trials (RCTs) suggested that the artichoke administration has an effect on both alanine aminotransferase (ALT) (Hedges' g, -1.08; 95% confidence interval [CI], -1.76 to -0.40; p = 0.002), and aspartate aminotransferase (AST) (Hedges' g, -1.02; 95% CI, -1.76 to -0.28; p = 0.007). Greater effects on ALT were detected in trials that lasted ≤8 weeks. Also, greater effects on AST were detected in trials using > 500 mg artichoke. Overall, this meta-analysis demonstrated artichoke supplementation decreased ALT and AST.
... Artichoke's leaves contain polyphenolic compounds, prebiotics (inulin), minerals, ascorbic acids, and folate [13]. Its leaf extract is rich in dietary fibers and antioxidant components [14], proposing the extract as beneficial in the control of HTN. Based on an experimental study, artichoke leaf extract also increases endothelial nitric oxide synthase (eNOS) gene expression and nitric oxide (NO) production in cultured human vascular endothelial cells and enhances endothelium-dependent vasodilation in mice aorta [15]. ...
... The current evidence is relatively limited and non-conclusive and only a few studies have reported that the supplementation of artichoke and artichoke products have a promising effect on controlling blood pressure [9][10][11][12]. While these findings are not supported by other studies [14,16,17]. A recent meta-analysis indicated that artichoke supplementation did not affect blood pressure. ...
... Of these articles, 10 were excluded because of the following reasons: irrelevant (n = 3), has no placebo-controlled group (n = 1), complex intervention (n = 1), without sufficient data for outcomes (n = 2), and conference abstracts (n = 3). Finally, 7 studies met all our inclusion criteria [9][10][11][12]14,16,17]. ...
Despite controversies, no earlier study has systematically summarized findings from earlier studies on the effect of artichoke supplementation on blood pressure. Therefore, current systematic review and meta-analysis was done on the effect of artichoke supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults. Five databases were searched from inception to January 2022 using relevant keywords. All randomized clinical trials investigating the impact of oral artichoke supplementation on any of the blood pressure parameters including SBP or/and DBP were included. Out of 1,507 citations, 7 trials that enrolled 472 subjects were included. Artichoke supplementation resulted in significant reduction in SBP (weighted mean difference [WMD], −2.01 mmHg; 95% confidence interval [CI], −3.78, −0.24; p = 0.026) and DBP (WMD, −1.45 mmHg; 95% CI, −2.81, −0.08; p = 0.038). Greater effects on SBP were detected in trials using ≤ 500 mg artichoke, lasted > 8 weeks, participants aged < 50 years' old and sample size ≤ 70. There was also a similar impact of artichoke on DBP. However, significant non-linear associations were found between artichoke supplementation dosage and study duration with both SBP (for dosage: p non-linearity = 0.002, for duration: p non-linearity = 0.016) and DBP (for dosage: p non-linearity = 0.005, for duration: p non-linearity = 0.003). We found a significant reduction in both SBP and DBP following artichoke supplementation in adults. It could be proposed as a hypotensive supplement in hypertension management.
... [38][39][40] The mean -SD for the change (within each group) was readily available in two studies. 41,42 The included studies were conducted between 2016 and 2019 and recruited a total of 333 NAFLD patients. The treatment period ranged from 4 to 24 weeks with a median of 8 weeks (interquartile range 8-16 weeks) while the average treatment period was 12 weeks. ...
... The reduction in HDL was higher in the ALE compared with the placebo group as reported by Panahi. 41 The reduction was not signicantly different between groups in three studies and only Radchenko et al. showed that ALE had a benecial effect on HDL. 40 Two studies did not report a statistically signicant difference in the D LDL levels between both the intervention and control groups. ...
... Doppler sonography showed signicant increased hepatic vein ow, reduced portal diameter, and liver size when NAFLD patients were treated with ALE. 41 Color Doppler ultrasound (US) of carotid arteries and US assessment of endothelial function revealed that the atherosclerotic markers carotid intima-media thickness and ow-mediated silation value were improved signicantly in NAFLD subgroups. 38 ...
Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease that can lead to liver cirrhosis, liver cancer, and death. Artichoke leaf extract (ALE) is well known in folk medicine for its hepatoprotective effect. Till recent times, no sufficient data from randomized clinical trials (RCTs) exist to support such use. This meta-analysis summarizes evidence from recent RCTs that evaluated ALE in NAFLD patients. Electronic databases were searched for RCTs that used ALE in NAFLD patients. The random-effects model was used to pool effect sizes (standardized change score). Data synthesis from five RCTs (333 patients) showed that ALE resulted in a significant reduction in alanine aminotransferase (standardized mean difference [SMD]: 1.1; 95% confidence interval [CI], 0.79-1.73; P < .001) and aspartate aminotransferase levels (SMD: 1.01; 95% CI, 0.52-1.51; P < .001) compared with the control group. ALE also resulted in a significant reduction in total cholesterol (SMD: 0.98; 95% CI, 0.53-1.43; P = .004), low-density lipoprotein (SMD: 0.96; 95% CI, 0.3-1.62; P < .001) and triglycerides (SMD: 0.95; 95% CI, 0.58-1.32; P < .001). The current review provides evidence from RCTs to support the use of ALE as a hepatoprotective agent in NAFLD patients. The study was registered on the PROSPERO database with the Registration No. CRD42020182502 (https://www.crd.york.ac.uk/prospero).
... After full-text review, four more studies were excluded due to the following reasons: irrelevant outcomes (n = 2), without sufficient data (n = 1), and review paper (n = 1). Finally, a total of 14 RCTs was included for the final systematic review and meta-analysis (Bundy, Walker, Middleton, Wallis, & Simpson, 2008;Englisch et al., 2000;Fallah Huseini, Kianbakht, & Heshmat, 2012;Gatmiri et al., 2019;Panahi et al., 2018;Rangboo et al., 2016;Rezazadeh et al., 2019;Khatereh Rezazadeh, Rezazadeh, & Ebrahimi-Mameghani, 2018;Roghani-Dehkordi & Kamkhah, 2009;Rondanelli et al., 2013;Rondanelli, Giacosa, Orsini, Opizzi, & Villani, 2011;Rondanelli et al., 2014;Rondanelli et al., 2020;Skarpanska-Stejnborn et al., 2008). ...
... The general characteristics of the 14 eligible trials are summarized in Table 1 (Englisch et al., 2000), and UK (Bundy et al., 2008). Apart from two studies that were exclusively conducted among men (Roghani-Dehkordi & Kamkhah, 2009;Skarpanska-Stejnborn et al., 2008), other studies were among both genders (Bundy et al., 2008;Englisch et al., 2000;Fallah Huseini et al., 2012;Gatmiri et al., 2019;Panahi et al., 2018;Rangboo et al., 2016;Rezazadeh et al., 2019;Rezazadeh, Aliashrafi, et al., 2018;Rondanelli et al., 2011;Rondanelli et al., 2013;Rondanelli et al., 2014;Rondanelli et al., 2020). All included RCTs utilized a parallel-group design. ...
... All included RCTs utilized a parallel-group design. The included studies had recruited subjects with hypercholesterolemia (Bundy et al., 2008;Englisch et al., 2000;Rondanelli et al., 2013), hypercholesterolemia with type 2 diabetes (Fallah Huseini et al., 2012), NASH (Rangboo et al., 2016), hypertension (Roghani-Dehkordi & Kamkhah, 2009), overweight and obesity with impaired fasting glucose (IFG) (Rondanelli et al., 2014;Rondanelli et al., 2020), NAFLD (Panahi et al., 2018), chronic kidney disease (Gatmiri et al., 2019), hypertriglyceridemia (Rezazadeh et al., 2019), metabolic syndrome (Rezazadeh, Aliashrafi, et al., 2018;, and nonhypercholestrolemic rowers (Skarpanska-Stejnborn et al., 2008). Artichoke was administered in varying doses from 50 to 2,700 mg/day for a duration of 5-12 weeks. ...
Accumulating evidence regarding the effect of artichoke on lipid profile is equivocal. We updated a previous meta‐analysis on the effect of artichoke extract supplementation on lipid profile and performed dose–response analysis. We searched PubMed, Scopus, Web of Science, and Cochrane Library from inception to June 2021 using relevant keywords. Papers from identified articles were collected. Two researchers rated the certainty in the estimates using the GRADE approach. Combining 15 effect sizes from 14 studies based on the random‐effects analysis, we found that artichoke significantly reduced TG (weighed mean difference [WMD]: −17.01 mg/dl, 95% CI: −23.88, −10.13, p = .011), TC (WMD: −17.01 mg/dl, 95% CI: −23.88, −10.13, p < .001), and LDL‐C (WMD: −17.48 mg/dl, 95%CI: −25.44, −9.53, p < .001). No significant effect of artichoke on HDL‐C level was detected (WMD: 0.78 mg/dl, 95%CI: −0.93, 2.49, p = .371). Combining the two effect sizes revealed that artichoke juice supplementation significantly reduced TG (WMD: −3.34 mg/dl, 95%CI: −5.51, −1.17, p = .003), TC (WMD: −18.04 mg/dl, 95%CI: −20.30, −15.78, p < .001), LDL‐C (WMD: −1.75 mg/dl, 95%CI: −3.02, −0.48, p = .007), and HDL‐C levels (WMD: −4.21 mg/dl, 95%CI: −5.49, −2.93, p < .001). In conclusion, we found that artichoke supplementation may favor CVD prevention by acting in improving the lipid profile.
... 11 Whilst a study conducted in NAFLD patients revealed that artichoke leaf extract supplementation substantially decreased ALT and AST levels, in comparison with the placebo group. 14 However, contrary to the positive findings reported above, Roghani-Dehkordi and Kamkhah reported no significant increases in AST levels after artichoke leaf juice supplementation. 15 Although some previous clinical trials have advocated the positive effects of artichoke on liver enzymes, the overarching results of previous studies are equivocal. ...
... to 70 years. The selected articles were conducted on NAFLD, 11,14,25 hypertensive, 15 11,14,15,24,25 Germany, 23 Italy, 22 and France, 21 respectively. The dose of artichoke ranged from 100 mg/day to 2700 mg/day, and the duration of administration varied from 4 to 12 weeks. ...
... to 70 years. The selected articles were conducted on NAFLD, 11,14,25 hypertensive, 15 11,14,15,24,25 Germany, 23 Italy, 22 and France, 21 respectively. The dose of artichoke ranged from 100 mg/day to 2700 mg/day, and the duration of administration varied from 4 to 12 weeks. ...
Objective
A systematic review and meta-analysis was conducted to summarize studies conducted on the effects of artichoke supplementation on liver enzymes.
Methods
Suitable studies were detected by searching online databases, including Medline, Embase, Cochrane Library, and Scopus databases, until 05 June 2021. As liver enzymes were reported in different units, standardized mean differences (SMD) were used and data were pooled using a random-effects model. Heterogeneity, publication bias, and sensitivity analysis were also assessed.
Results
Pooled analysis, of eight clinical trials, revealed that artichoke supplementation significantly reduced the concentration of aspartate aminotransferase (AST) (P=0.001) and alanine transaminase (ALT) (; P = 0.016), in comparison with placebo. Subgroup analysis suggested that artichoke administration significantly reduces AST and ALT in patients with non-alcoholic fatty liver disease (P=0.003 for AST and P<0.001 for ALT), and ALT among overweight/obese subjects (P=0.025).
Conclusions
Artichoke supplementation elicited significant reductions in liver enzymes, especially among patients with non-alcoholic fatty liver disease.
... In healthy hypercholesterolemic adults, ALE treatment (1280 mg daily for 12 weeks) decreases plasma total cholesterol by 4.2% [9]. In patients with diagnosed NAFLD, ALE treatment (600 mg daily for 9 weeks) reduces liver size, serum total cholesterol and triglyceride concentrations [10]. In a rat model of a high-fat diet, ALE limits hepatic disorders by reducing the fatty liver deposition in the hepatic lobule [11]. ...
... At the cellular level, we found that: (1) ALE metabolites exert hepatoprotective properties in human hepatocytes by counteracting a fatty acid-induced lipotoxic stress that is commonly observed in hypercholesterolemia [9] and steatohepatitis [10]; (2) ALE metabolites limit adipogenic differentiation and hypertrophy, a cellular feature of obesity and metabolic syndrome [23]; (3) finally, ALE metabolites protect chondrocyte from an IL-1β stimulation that mimics osteo-arthritis inflammatory environment [14]. ...
... These doses of 400 mg/kg/day in rats and 1.6 g/kg/day in mice for 10 to 56 days correspond to 8 to 15 g/day in humans according to the metabolic weight conversion table. In humans, the average dose for a chronic exposure is around 1.8 g, ranging from 250 to 3200 mg for 5 to 12 weeks (250 [46]; 1200 [9,22]; 600 [10]; 1800 [23,47]; 3200 mg [48]). ...
The aging of our population is accompanied by an increased prevalence of chronic diseases.
Among those, liver, joint and adipose tissue-related pathologies have a major socio-economic
impact. They share common origins as they result from a dysregulation of the inflammatory and
metabolic status. Plant-derived nutrients and especially polyphenols, exert a large range of beneficial
effects in the prevention of chronic diseases but require clinically validated approaches for optimized
care management. In this study, we designed an innovative clinical approach considering
the metabolites produced by the digestive tract following the ingestion of an artichoke leaf extract.
Human serum, enriched with metabolites deriving from the extract, was collected and incubated
with human hepatocytes, human primary chondrocytes and adipocytes to determine the biological
activity of the extract. Changes in cellular behavior demonstrated that the artichoke leaf extract protects
hepatocytes from lipotoxic stress, prevents adipocytes differentiation and hyperplasia, and exerts
chondroprotective properties in an inflammatory context. These data validate the beneficial
health properties of an artichoke leaf extract at the clinical level and provide both insights and further
evidence that plant-derived nutrients and especially polyphenols from artichoke may represent
a relevant alternative for nutritional strategies addressing chronic disease issues.
... Several clinical studies have assessed the efficacy of silibinin in reducing transaminases. For instance, in a meta-analysis of eight randomized clinical trials involving 587 patients, silibinin demonstrated a positive effect in reducing transaminase levels in patients with nonalcoholic fatty liver disease (NAFLD) [31][32][33]. Certainly, artichoke also exhibits hepatoprotective properties, as evidenced by studies in the literature. For example, in animal studies, liquid extracts of the roots and leaves of artichoke are able to protect the liver, possibly even to help liver cells regenerate [30][31][32]. ...
... Moreover, a randomized doubleblind placebo-controlled parallel-group trial was conducted to determine if artichoke leaf extract had therapeutic utility in patients with established NAFLD. It showed a reduction in serum ALT (p < 0.001) and AST (p < 0.001) levels, an improvement in the AST/ALT ratio and APRI scores (p < 0.01), and a reduction in total bilirubin [33][34][35][36]. Regarding the lipid profile, we observed a 9.4% reduction in total cholesterol, an 8% increase in HDL, and a 10% reduction in triglycerides: all non-statistically significant (p > 0.05). ...
Background: In Western countries, 10–20% of adults have gallstones, of which about 1–3% of patients are symptomatic for biliary colic. The treatment with ursodeoxycholic acid is debated. Silymarin is emerging nowadays as a natural substance with choleretic and beneficial properties, useful in the case of gallbladder sludge. Aim: The aim of our study was to evaluate the efficacy of supplementation with a mix of natural compounds (milk thistle 150 mg, artichoke 150 mg, and green tea 150 mg) in patients affected by biliary sludge in reducing biliary colic and biliary sludge and improving lipid profiles after 3 months of treatment compared to a control group. Patients and Methods: This was an interventional open study on 65 consecutive adult patients (23 M/42 F; mean age 61.0 ± 18.7 years) affected by biliary sludge without indication for surgery, admitted to the Internal Medicine Department of San Carlo di Nancy Hospital Rome. Forty patients were treated with milk thistle 150 mg, artichoke 150 mg, and green tea 150 mg, 2 capsules/day for three months, and followed up for abdominal ultrasound, the frequency of occurrence of biliary colic, and blood tests. Twenty-five control group patients were followed up for abdominal ultrasound, the frequency of occurrence of biliary colic, and blood tests after 3 months. Results: In Group A, we observed a disappearance of biliary sludge in 32.4% (12/37) of patients compared to 8.7% in the control group (p < 0.05). In 32.4% of treated patients, we report a reduction in biliary sludge. There were no side effects during treatment. In both groups, we registered a significant reduction in transaminases and gamma-glutamyl transferase (γ-GT) (p < 0.05). No significant modification of the lipid profile was observed. Conclusions: The treatment with a mix of natural compounds (milk thistle, artichoke, and green tea) in patients affected by symptomatic biliary colic resulted in efficacy and safety in reducing biliary sludge, biliary colic, and transaminases levels after three months of treatment. The limitations of this study include a small number of patients and the absence of long-term follow up after the end of treatment.
... Co ważniejsze, ELK miał także wymierny wpływ na ciężkość choroby. Podczas badania poprawił się stan 81,6% pacjentów przyjmujących ELK wobec jedynie 5,0% pacjentów z grupy kontrolnej [29]. ...
... Należy tu zaznaczyć, że wnioski te wypływają z metaanalizy wielu badań, w których brali udział pacjenci obciążeni różnymi schorzeniami. Pacjentów z niealkoholowym stłuszczeniem wątroby lub niealkoholowym stłuszczeniowym zapaleniem wątroby dotyczyły jedynie 2 z 7 analizowanych prac, ale w obu zaobserwowano opisany tu ogólniej efekt terapeutyczny [29,31]. ...
Karczoch zwyczajny (Cynara scolymus) jest znany za sprawą dużej zawartości aktywnych biologicznie metabolitów: polifenoli oraz terpenoidów. Przypisuje im się działanie hipolipidemiczne, antydyspeptyczne, hepatoprotekcyjne oraz antyoksydacyjne. Mimo to liczba dobrej jakości badań klinicznych dokumentujących działanie lecznicze karczocha i ekstraktu z jego liści (ELK) jest stosunkowo niewielka. Zgromadzone w nich dowody zdają się potwierdzać pozytywny wpływ ELK w hipercholesterolemii i dyspepsji czynnościowej. Sugerują też możliwy efekt terapeutyczny u chorych na niealkoholowe stłuszczeniowe zapalenie wątroby i zespół jelita drażliwego. We wszystkich tych przypadkach potrzebne są dalsze rygorystyczne badania kliniczne, które pozwolą skwantykować obserwowane efekty i dawki ELK konieczne do ich wywołania. Dowody zdają się wykluczać jakiekolwiek działanie ELK w leczeniu wirusowego zapalenia wątroby typu C oraz kaca alkoholowego.
... Two previous studies showed the beneficial effect of artichoke leaf extract (ALE) alone (Panahi et al., 2018) or in combination with metformin or vitamin E (Majnooni et al., 2021) in individuals with non-alcoholic fatty liver disease (NAFLD). Other scientific articles reported that artichoke extracts improve NAFLD in rodents (Deng et al., 2022;Lee et al., 2021b). ...
... Previous studies found that ALE intake alone (Panahi et al., 2018) or in association with metformin or vitamin E (Majnooni et al., 2021) improves lipid profile in individuals with NAFLD. A study by Rangboo et al. (2016) showed that ALE consumption is effective in lowering triglycerides, total cholesterol and lowdensity lipoprotein cholesterol (LDL-C) in a cohort of 60 individuals with NASH. ...
Cynara scolymus L., called artichoke or globe artichoke, is a perennial herbaceous plant cultivated worldwide. This plant is a common component of the Mediterranean diet and has been used as a remedy for health conditions since antiquity. The aim of this review is to find the health-promoting properties of artichoke, conducting a literature search in PubMed. The results show that 119 studies describe these effects and 17 health benefits of artichoke are reported in the scientific literature. Antioxidant activity and effects on the liver and lipid profile are the main health-promoting properties of this plant. We found that artichoke also improves cardiovascular and gastrointestinal health and exerts anticancer, antimetabolic and antiobesity, prebiotic and probiotic, renoprotective and antidiabetic activities. Only one or two research articles reported the positive effects of this plant on the immune system, arthritis, photoaging, the reproductive system, the nervous system, fungal infections and periodontal diseases. The health benefits are mainly exerted by phenolics. In conclusion, this review shows the health-promoting properties of artichoke. The main beneficial effects are antioxidant activity and effects on lipid profile and the liver, which are mainly mediated by phenolics. The results of the scientific articles described in this review and the molecular mechanisms related to the health benefits of artichoke should be confirmed by future experimental studies.
Impact statement: Artichoke (Cynara scolymus L.) has many health benefits and the
main properties are antioxidant activity and effects on the liver and lipid profile.
... Many natural bioactive components isolated from fruits, vegetables, and fish or produced by microorganisms could be promising agents capable of reversing NAFLD [11,12]. In particular, some studies suggested that ω-3 polyunsaturated fatty acids (PUFAs) [12,13]; curcumin [12,14]; bergamot polyphenol fraction (BPF) [15,16]; artichoke leaf extract [15][16][17][18]; black seed oil of Nigella sativa [19]; and the standardised fraction "Picroliv" of the root of Picrorhiza kurroa [20,21] have anti-oxidant, anti-inflammatory, hypolipidemic and hypoglycemic proprieties [22,23]. Moreover, they can also reduce hepatic steatosis and other liver injury, both in preclinical and clinical studies [12][13][14][15][16][17][18][19][20][21]. ...
... In particular, some studies suggested that ω-3 polyunsaturated fatty acids (PUFAs) [12,13]; curcumin [12,14]; bergamot polyphenol fraction (BPF) [15,16]; artichoke leaf extract [15][16][17][18]; black seed oil of Nigella sativa [19]; and the standardised fraction "Picroliv" of the root of Picrorhiza kurroa [20,21] have anti-oxidant, anti-inflammatory, hypolipidemic and hypoglycemic proprieties [22,23]. Moreover, they can also reduce hepatic steatosis and other liver injury, both in preclinical and clinical studies [12][13][14][15][16][17][18][19][20][21]. Many other natural compound are reported to have beneficial effects on NAFLD, including indole-3-carbinol (I3C) found in cruciferous vegetables [24][25][26]; silymarin [12,27,28] and silybin [29,30] isolated from milk thistle; luteolin found in fruits, vegetables, and natural herbs [31,32] astaxanthin produced by microalgae [33] and many others [34][35][36][37][38][39][40]. ...
Background
Currently, there is no approved medication for non-alcoholic fatty liver disease management. Pre-clinical and clinical studies showed that several bioactive molecules in plants or foods (i.e., curcumin complex, bergamot polyphenol fraction, artichoke leaf extract, black seed oil, concentrate fish oil, picroliv root, glutathione, S -adenosyl- l -methionine and other natural ingredients) have been associated with improved fatty liver disease. Starting from these evidences, our purpose was to evaluate the effects of a novel combination of abovementioned nutraceuticals as a treatment for adults with fatty liver disease.
Methods
A total of 140 participants with liver steatosis were enrolled in a randomized, double-blind, placebo controlled clinical trial. The intervention group received six softgel capsules daily of a nutraceutical (namely Livogen Plus®) containing a combination of natural bioactive components for 12 weeks. The control group received six softgel capsules daily of a placebo containing maltodextrin for 12 weeks. The primary outcome measure was the change in liver fat content (CAP score). CAP score, by transient elastography, serum glucose, lipids, transaminases, and cytokines were measured at baseline and after intervention.
Results
After adjustment for confounding variables (i.e., CAP score and triglyceride at baseline, and changes of serum γGT, and vegetable and animal proteins, cholesterol intake at the follow-up), we found a greater CAP score reduction in the nutraceutical group rather than placebo (− 34 ± 5 dB/m vs. − 20 ± 5 dB/m, respectively; p = 0.045). The CAP score reduction (%) was even greater in those with aged 60 or less, low baseline HDL-C, AST reduction as well as in men.
Conclusion
Our results showed that a new combination of bioactive molecules as nutraceutical was safe and effective in reducing liver fat content over 12 weeks in individuals with hepatic steatosis.
Trial registration ISRCTN, ISRCTN70887063. Registered 03 August 2021—retrospectively registered, https://doi.org/10.1186/ISRCTN70887063
... These include Silybum marianum (L.) Gaertn. and Cynara cardunculus L. [6][7][8] Brazil hosts 15-20 % of the world's biodiversity, [9] and is estimated to have up to 45,000 plant species, many of them with potential medicinal use. [10] In this context, Brazilian 'caboclos' and communities from rural areas are important sources of ethnobotanical knowledge associated with phytotherapy, established over many years of empirical experimentation involving a mixture of European, African and indigenous practices relating to the use of plants belonging to the native flora. ...
... Out of all the species documented, 56.4 % (153) are native to the Brazilian flora, accounting for 292 citations, spread across 108 genera belonging to 54 botanical families ( Table 1). Fabaceae and Asteraceae were the most dominant families, with 18 and 16 species, respectively, followed by Apocynaceae (8) and Solanaceae (7). The relatively high number of species belonging to the Fabaceae and Asteraceae families is consistent with previous ethnobotanical studies performed in Brazil, [17,18] and might be explained by their great abundance and accessibility. ...
Ethnobotanical studies have established that the folk use of plants for hepatobiliary disorders is very common in Brazil. This review aimed to compile, describe and discuss the main native Brazilian medicinal plants used as hepatoprotective agents listed on 25 books by authors from various regions in the country. Based on the 153 species found, a comprehensive analysis of the most relevant scientific studies is presented, including Piper umbellatum , Echinodorus macrophyllus , Fevillea trilobata and Achyrocline satureioides. Some medicinal plants share both a large number of citations and scientific evidence to corroborate their hepatoprotective effects, including Solanum paniculatum , Baccharis crispa and Phillanthus niruri , which could be of interest to develop new phytomedicines. Additionally, some active ingredients are indicated as being responsible for the liver protective effects described, particularly phenolic compounds (flavonoids, coumestans and lignans).
... The results showed that artichoke leaf extract significantly lowered liver enzymes and improved lipid metabolism. The study findings suggest that artichoke leaf extract may be a potential natural treatment option for the treatment of NAFLD (20). Although larger-scale studies are needed, these results support the positive effects of artichoke on liver health, and suggest that the mechanisms of these plants that support liver health may play an important role in the treatment of metabolic disorders. ...
... 10 So, the first line of treatment is always strong metabolic control achieved by dietary change and increased physical activity, but this is seldom totally effective in reversing this condition, especially at late stages. [11][12][13] Therefore, there appears to be a need for complementary therapies to stop or delay the development of NAFLD. Some herbs and medicinal plants are frequently used for disease treatment or prevention. ...
Objectives: Curcumin has antioxidant properties and has been proposed as a potential treatment for NAFLD. The
aim of current systematic review and meta-analysis was to evaluate previous findings for the effect of curcumin
supplementation on glycaemic indices, lipid profile, blood pressure, inflammatory markers, and anthropometric
measurements of NAFLD patients.
Methods: Relevant studies published up to January 2024 were searched systematically using the following databases: PubMed, SCOPUS, WOS, Science Direct, Ovid and Cochrane. The systematic review and meta-analysis
were conducted according to the 2020 PRISMA guidelines. The quality of the papers was assessed the using
the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Pooled effect sizes were calculated using a random effects model and reported as the WMD and 95% CI. Also, subgroup analyses were done to find probable sources
of heterogeneity among studies.
Results: Out of 21010 records initially identified, 21 eligible RCTs were selected for inclusion in a meta-analysis.
Overall, 1191 participants of both genders, 600 in the intervention and 591 in the control group with NAFLD
were included. There are several limitations in the studies that were included, for instance, the results are
weakened substantially by potential bias or failure to account for potential adulteration (with pharmaceuticals)
or contamination (with other herbs) of the curcumin supplements that were tested. However, previous studies
have reported curcumin to be a safe complementary therapy for several conditions. Our study indicated that
curcumin supplementation in doses of 50− 3000 mg/day was associated with significant change in FBG [WMD: − 2.83; 95% CI: − 4.61, − 1.06), I2 = 51.3%], HOMA-IR [WMD: −0.52; 95% CI: − 0.84, − 0.20), I2= 82.8%], TG [WMD: − 10.31; 95% CI: − 20.00, − 0.61), I
2 = 84.5%], TC [WMD: − 11.81; 95% CI: − 19.65, − 3.96), I
2
= 94.6%], LDL [WMD: − 8.01; 95% CI: − 15.79, − 0.24), I
2 = 96.1%], weight [WMD: − 0.81; 95% CI: − 1.28,
− 0.35), I
2= 0.0%] and BMI [WMD: − 0.35; 95% CI: − 0.57, − 0.13), I
2= 0.0%] in adults with NAFLD. There was
no significant change in HbA1C, plasma insulin, QUICKI, HDL, SBP, DBP, CRP, TNF-α and WC after curcumin
therapy. Subgroup analysis suggested a significant changes in serum FBG, TG, SBP, WC in RCTs for intervention
durations of ≥ 8 weeks, and SBP, TG, LDL, HDL, BMI, WC in RCTs with sample size > 55 participants.
Conclusion: Curcumin supplementation in doses of 50− 3000 mg/day over 8–12 weeks was associated with significant reductions in levels of FBG, HOMA-IR, TG, TC, LDL, weight and BMI in patients with NAFLD. Previous
studies have reported curcumin as a safe complementary therapy for several diseases. We would suggest that
should curcumin supplements be used clinically in specific conditions, it should be used with caution. Also,
difference in grades of NAFLD may effect the evaluated outcomes, so it is suggested that future studies be
conducted with an analyses on subgroups according to their NAFLD grade. Furthermore, because of the failure to
conduct independent biochemical assessment of the turmeric/curcumin product used in most studies as well as
potential sources of bias, results should be interpreted with caution.
... Кроме того, ЭЛА продемонстрировал регенеративные свой ства, о чем свидетельствовала более низкая активность АЛТ, АСТ и супероксиддисмутазы в группе, получавшей ЭЛА после воздействия CCl 4 . Ученые из Ирана и Катара в рандомизированном двой ном слепом плацебоконтролируемом исследовании [17] в параллельных группах у пациентов с неалкогольной жировой болезнью печени (НАЖБП) изучали гепатопротективные свой ства ЭЛА. При лечении ЭЛА по сравнению с плацебо доплерография показала увеличение кровотока в печеночных венах (P < 0,001), уменьшение диаметра воротной вены (P < 0,001) и размера печени (P < 0,001), снижение уровня АЛТ в сыворотке (P < 0,001) и AСT (P < 0,001), улучшение соотношения AСT/AЛT (P < 0,01), а также снижение общего билирубина. ...
Introduction . Non-alcoholic fatty liver disease (NAFLD) is caused by excess accumulation of fats in hepatocytes. An increasing percentage of adipose tissue is associated with chronic inflammation and developing oxidative stress. These pathological conditions can lead to the progression of steatosis to steatohepatitis with the further development of fibrosis and cirrhosis.
Aim . To evaluate the indicators of lipid peroxidation and antioxidant defence factors in steatosis and steatohepatitis in patients with NAFLD.
Materials and methods . During the work, 116 patients with NAFLD were examined, of which 65 had steatosis, and 51 had steatohepatitis. The study of biochemical markers of metabolism of proteins, fats and carbohydrates was performed on a Mindray BS-380 biochemical analyzer. The indicators of the LPO-AOD system (MDA, SOD, catalase, ceruloplasmin) were assessed using spectrophotometric methods. Statistical data processing was carried out in the STATISTICA and SPSS 26 programs using nonparametric tests.
Results . Patients with steatohepatitis had more severe dyslipidemia, blood triglyceride, total cholesterol levels and LDL were significantly higher (p > 0.05). Impaired cholesterol metabolism was reflected by a high atherogenic index of 3.46. In patients with steatosis, changes in the lipid profile were less pronounced. No disturbances in protein and carbohydrate metabolism were detected. Increased levels of liver markers were noted only in patients with steatohepatitis. The change in the balance in the LPO- AOD system was more pronounced in patients with steatohepatitis; they had a high level of MDA, a high concentration of catalase; in patients with steatosis, only a decrease in the level of MDA and an increase in the level of ceruloplasmin were noted.
Conclusion . Dyslipidemia, hepatocyte cytolysis and liver fibrosis are detected in patients with steatohepatitis. Disturbances in the LPO-AOD system have been identified in both forms of NAFLD, but in steatosis they are compensated. In steatohepatitis, disturbances in “LPO-AOD” in the form of an increase in pro-oxidants and a decrease in antioxidants cause the development of oxidative stress.
... Phenolic compounds such as caffeic acid and isochlorogenic acid exert hepatoprotective effects by inhibiting oxidative stress through increasing Nrf2 expression, enhancing antioxidant enzyme activities and exerting a protective effect against liver injury [136]. The study by Panahi et al. [99] observed changes in liver size, a reduction in portal vein diameter and a reduction in total bilirubin after consumption of artichoke extract for 8 weeks in adult NAFLD, as well as a reduction in ALT and AST and lipid markers as triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Another study observed a hepatoprotective effect of artichoke in rats after the induction of toxicity with lead (Pb), reporting a reduction in serum levels of ALT, AST, TG, very-low-density lipoprotein cholesterol (VLDL-C) and MDA [96]. ...
Cynara scolymus L. is an herbaceous plant originally from the western Mediterranean area, with Italy, Spain and France the main being producers. Both the edible flowering head and the by-products generated during processing (outer bracts, leaves and stem) are characterized by a high content of essential vitamins, minerals and bioactive compounds. In particular, the leaves represent a great source of phenolic acids derived from caffeoylquinic acid or flavonoids such as luteonin and apigenin, while the head and stem contain a high content of soluble and insoluble dietary fiber, especially inulin and pectins. Its high content of bioactive compounds provides artichoke a high antioxidant power due to the modulation effect of the transcription factor Nrf2, which may lead to protection against cardiovascular, hepatic and neurological disorders. The potential use of artichoke as a functional ingredient in the food industry may be promising in terms of improving the nutritional value of products, as well as preventing oxidation and extending the shelf-life of processed foods due to its antimicrobial activity. This review aims to provide an overview of the nutritional qualities of Cynara scolymus L. and its by-products, focusing on the possible health effects and potential applications in food products as a higher-value-added alternative ingredient.
... They found that the milk thistle extract reduced serum levels of total cholesterol, triglyceride, LDL and the serum activity of aspartate aminotransferase; the artichoke extract only decreased triglyceride levels. In addition, various systematic reviews and meta-analyses indicate that artichoke supplementation decreases aspartate aminotransferase and alanine aminotransferase in patients with nonalcoholic fatty liver diseases and obese or overweight subjects [90][91][92][93][94][95][96]. It has also been found that artichoke extracts improve non-alcoholic fatty liver disease and alcoholic liver disease in rodents [65,97,98]. ...
Cynara scolymus, also known as the globe artichoke or artichoke, is grown as a food, mainly in the Mediterranean, Canary Islands, and Egypt, as well as in Asia and South America. It has also been associated with various health benefits and is used in plant-based dietary supplements and herbal infusions. Its edible parts, consisting of the head or capitula, flower, and leaves, have shown various biological activities, including anti-cancer, hepatoprotective and antimicrobial potential. The leaves are mainly used in infusions and extracts for their health-promoting properties, although all their edible parts may also be consumed as fresh, frozen, or canned foods. However, its primary health-promoting activity is associated with its antioxidant potential, which has been linked to its chemical composition, particularly its phenolic compounds (representing 96 mg of gallic acid equivalent per 100 g of raw plant material) and dietary fiber. The main phenolic compounds in the heads and leaves are caffeic acid derivatives, while the flavonoids luteolin and apigenin (both present as glucosides and rutinosides) have also been identified. In addition, heat-treated artichokes (i.e., boiled, steamed or fried), their extracts, and waste from artichoke processing also have antioxidant activity. The present paper reviews the current literature concerning the biological properties of different parts of C. scolymus, its by-products and dietary supplements, as well as their chemical content and toxicity. The literature was obtained by a search of PubMed/Medline, Google Scholar, Web of Knowledge, ScienceDirect, and Scopus, with extra papers being identified by manually reviewing the references.
... Studies have indicated that the supplementation of artichokes is beneficial to the livers of non-alcoholic fatty liver disease (NAFLD) patients. 7 Artichoke supplements can inhibit the inflammation and cell apoptosis induced by H 2 O 2 (the oxidative stress induced in HepG2 cells). Studies have indicated that in the NAFLD development process, artichoke supplements can inhibit the inflammation and apoptosis of liver cells directly and may help to prevent the progression of liver diseases, including hepatic steatosis and non-alcoholic steatohepatitis. ...
Background: Population aging is coupled with an increased morbidity rate of chronic diseases, and the lesions are mostly related to the liver, joints, and adipose tissues. Chronic diseases not only influence personal health but also increase national health and medical expenses. Non-alcoholic fatty liver disease (NAFLD) is the most familiar chronic liver disease (CLD) in the world. It will cause liver fibrosis or death without treatment, but there is no certified drug for treatment. According to many studies, artichoke (Cynara scolymus L.) extract, Kenponashi (Hoveniadulcis thunberg) extract, sanghuangporus sanghuang (Phellinuslinteus) extract, fructus schisandrae (Schisandra chinensis) extract, sesame (Sesamum indicum) extract, vitamin B complex and vitamin E have potential in resisting inflammation and liver fibrosis, but this novel combination for improving hepatic injury has not been studied or discussed in practice. Objective: This experiment discussed the effect of an artichoke compound (AHC) formula containing artichoke extract, Kenponashi extract, sanghuangporus sanghuang extract, fructus schisandrae extract, sesame extract , vitamin B complex and vitamin E on improving the chronic hepatitis of rats induced by carbon tetrachloride(CCl4). Design: A total of 50 six-week-old male Wistar rats were divided into five groups for use in the experiment, including the control group and four experimental groups (CCl4). The CCl4 groups were given carboxymethylcellulose (CMC) or AHC (318, 636 and 1,590 mg/kg, represented by AHC-L, AHC-M, and AHC-H, respectively). All rats were fed AHC for one week at first. Starting from the second week, the control group was fed olive oil (0.2 ml/100 g) per os, while the experimental group was fed with CCl4 20% twice per week for eight-weeks. During the experimental period, CMC or AHC was given to the rats once per day. All rats were sacrificed in the ninth-week to analyze their body weight, food intake, body fat content, serum biochemical value and liver lipids. Results: The results showed that the final spleen weight of the CCl4 +AHC-H group was significantly lower than that of the CCl4 +CMC group; the AST concentration in the plasma of the CCl4+AHC-L, M and H groups was significantly lower than that of the CCl4+CMC group; the ALT concentration in the plasma of the CCl4+AHC-H group was significantly lower than that of the CCl4+CMC group; the triglyceride and cholesterol concentrations in the plasma of the CCl4+AHC-L, M and H groups were significantly lower than that of the CCl4+CMC group; the GSH concentration in the livers of the CCl4+AHC-L and H groups was significantly higher than that of the CCl4+CMC group; the hepatic fibrosis of the CCl4+AHC-L, M and H groups were significantly lower than that of the CCl4+CMC group (p<0.05). Conclusion: AHC could reduce the ALT and AST values of rat plasma induced by CCl4, increase the antioxidant GSH content in the liver, and reduce the degree of hepatic fibrosis. It has the potential to be a natural and mild plant extract dietary supplement. Its long-term administration effect on the human body should be observed in the future.
... There is also a study that checked the effects of artichoke leaf extracts without any addition on NAFLD subjects. At the endpoint of the intervention, NAFLD severity decreased, and improvements in the lipid profile, liver ultrasound parameters, and levels of hepatic enzymes in plasma were observed [147]. ...
There is a need to introduce standardized treatment options for non-alcoholic fatty liver disease (NAFLD) due to its global prevalence and the complications of this disease. Many studies have revealed that food-derived substances may be beneficial in dealing with this disease. Therefore, this review aims to evaluate the recently published studies on the food-derived treatment options for NAFLD. A comprehensive search of the PubMed database using keywords such as “NAFLD”, “nutrition”, “food”, “derived”, “therapy”, and “guidelines” yielded 219 relevant papers for our analysis, published from 2004 to 2023. The results show the significant benefits of food-derived treatment in NAFLD therapy, including improvements in liver histology, hepatic fat amounts, anthropometric measures, lipid profile, and other metabolic measures. The availability of the substances discussed makes them a significant adjuvant in the treatment of this disease. The usefulness of Viusid as additional therapy to diet and physical activity should be emphasized due to improvements in liver histology; however, many other substances lead to a decrease in liver fat amounts including, e.g., berberine or omega-3 fatty acids. In addition, the synbiotic Protexin seems to be useful in terms of NAFLD treatment, especially because it is effective in both obese and lean subjects. Based on the latest research results, we suggest revising the therapeutic recommendations for patients suffering from NAFLD.
... Nhìn chung, việc sử dụng đồng thời ALE với vitamin E và metformin làm giảm men gan tốt hơn so với việc sử dụng đồng thời metformin với vitamin E và cải thiện các biến chứng ở bệnh nhân NAFLD [106]. Một số nghiên cứu lâm sàng khác cũng cho kết quả tương tự gồm thử nghiệm trên 60 người bị NAFLD (2700 mg/ngày × 12 tháng) [102]; Trên 100 người NAFLD (600 mg/ngày × 2 tháng) [108]. ...
Tóm tắt-Actisô (Cynara scolymus L., Asteraceae), hoa tự dạng đầu được dùng chủ yếu làm thực phẩm và cao chiết lá thường dùng làm thuốc thảo dược trong điều trị chứng khó tiêu, đầy hơi, và viêm gan. Bài báo này nhằm tóm tắt các đặc điểm thực vật đặc biệt là sự đa dạng di truyền, thành phần hóa học, tác dụng dược lý, các thử nghiệm lâm sàng, các phương pháp phân tích và một số yếu tố ảnh hưởng đáng kể đến hàm lượng của polyphenol. Actisô giàu các polyphenol có hoạt tính sinh học bao gồm acid caffeoylquinic, flavonoid… Bên cạnh đó, inulin là polysaccharid fructan trong Actisô, được dùng để kiểm tra chức năng thận và dùng trong thực phẩm. Các sesquiterpen lacton và triterpen là thành phần kém phân cực cũng được tìm thấy trong Actisô. Actisô có giá trị dinh dưỡng cao và có tính chất trị liệu như chống oxy hóa, bảo vệ gan, lợi mật, kháng viêm, hạ lipid máu. Các acid phenol đã được phân tích bằng phương pháp sắc ký lỏng hiệu năng cao (HPLC) và siêu hiệu năng (UHPLC) kết nối với các đầu dò PDA và MS.
Abstract-Cynara scolymus L., Asteraceae, whose flower head is primarily used as food and whose leaf extract (ALE) used commonly as herbal medicine for treating dyspepsia, flatulence, and hepatitis. This review article aims to summarize the botanical characteristics, especially the genetic diversity, phytochemistry, pharmacological activities, clinical trials, analytical methods and some factors notably influencing the content of polyphenols. C. scolymus contains large amounts of bioactive phenolic compounds including caffeoylquinic acids, flavonoids… Besides, inulin a fructan polysaccharide found in C. scolymus is often used for tests of renal function and food ingredient. The sesquiterpenes lactones and triterpenes, non-polar compounds, are also found in C. scolymus. C. scolymus has important nutritional value and therapeutic properties such as antioxidant, hepatoprotective, choleretic, anti-inflammatory, blood lipid-lowering activity... The phenolic acids were analyzed by high-performance liquid chromatography (HPLC), ultra-high-performance liquid chromatography (UHPLC) coupled to photodiode array detector (PDA) and mass spectrometry detector. Từ khóa-Actisô (Cynara scolymus L.); Cynara cardunculus; cynarin; acid chlorogenic.
... This supplement could also be used in statin-intolerant individuals [190], for its hepatoprotective activity, which is demonstrated by its reduction of elevated serum ALT activity. A few cases of minor and transient gastrointestinal effects (mainly abdominal discomfort) have been reported [191]. Even though the artichoke leaf extract could represent an adjuvant in the regulation of lipid profile and liver levels of AST and ALT in NAFLD patients, long-term RCTs are still missing and needed to confirm both the safety and efficacy of this nutraceutical. ...
Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even >50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease. The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.
... At the same time, another study examined the protective effects of artichoke leaf extract on the liver of NAFLD patients: in this study, subjects suffering from NAFLD were treated with 600 mg/day of artichoke leaf extract for a period of two months. Patients who were given artichoke extract showed reduction of total cholesterol, low-density lipoprotein cholesterol, triglyceride concentrations, liver enzymes and total bilirubin compared to the control group [113]. Lee et al. evaluated the effect of artichoke leaf extract in two experimental models: in vivo on the livers of mice with NAFLD induced as a result of high fat/high fructose diet; in vitro on HepG2 liver cells in which oxidative stress was induced following treatment with H2O2. ...
Non-alcoholic fatty liver disease (NAFLD) is considered one of the leading causes of liver-related morbidity and mortality. NAFLD is a cluster of liver disorders that includes the accumulation of fat in the liver, insulin resistance, diffuse steatosis, lobular inflammation, fibrosis, cirrhosis and, in the latter stages, liver cancer. Due to the complexity of the disease and the multifactorial basis for the development of liver dysfunction, there is currently no unique drug treatment for NAFLD and the pharmacological options are inconclusive. In recent years, natural products have been studied for their potential beneficial effect in both preventing and treating fatty liver and its consequences in both local and systemic effects related to NAFLD. In particular, bergamot polyphenolic fraction (BPF), which is rich in natural polyphenols, and Cynara cardunculus wild type (which contains large quantities of sesquiterpenes, caffeic acid derivatives and luteolin) have both been investigated in both pre-clinical settings and clinical studies showing their effect in counteracting NAFLD-related health issues. In the present review we summarize the experimental and clinical evidence on the effect of BPF and Cynara extract alone or in their combination product (Bergacyn®) in NAFLD. In particular, data reported show that both extracts may synergize in counteracting the pathophysiological basis of NAFLD by inhibiting lipid accumulation in liver cells, oxidative stress and inflammation subsequent to liver syeatosis and, in the latter stages, liver fibrosis and tissue degeneration. Moreover, due to its powerful vasoprotective effect, the combination of BPF and Cynara extract (Bergacyn®) leads to improved endothelial dysfunction and cardioprotective response in both animal models of NAFLD, in veterinary medicine and in humans. Thus, supplementation with BPF and Cynara Cardunculus extract and their combination product (Bergacyn®) represent a novel and potentially useful approach in preventing and treating NAFLD-associated complications.
... These findings were consistent with previous research findings. Panahi et al. reported that supplementation with 600 mg of artichoke leaf extract for 2 months significantly decreased serum levels of ALT and AST, improved AST/ALT ratio and APRI scores, and reduced total bilirubin compared to the placebo [26]. Another study conducted by Tang et al. has highlighted a protective effect of artichoke components against acute alcoholinduced liver injury in mice, by showing that an artichoke ethanolic extract significantly decreased AST and ALT in the injured liver. ...
Pre-obesity is a condition that predisposes to the risk of developing obesity, cardiovascular diseases (CVD), and diabetes. Our previous study demonstrated that a Cynara cardunculus (L.) based nutraceutical named Altilix® (Bionap, Italy), containing chlorogenic acid and luteolin extracts, was able to improve several hepatic and cardio-metabolic parameters. Given this background, we conducted a post-hoc analysis of the Altilix® study in order to analyze the supplement’s effects in the subgroup of pre-obesity subjects on anthropometry (weight and waist circumference), glucose metabolism (HbA1C, HOMA-IR, and HOMA-β), lipid profile (total cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol), hepatic functionality (FLI, AST, ALT and AST/ALT), carotid-media thickness (CIMT) and endothelial function (FMD). Fifty subjects from the original study cohort (which consisted of 100 subjects) were chosen with BMI ≥ 25 and < 30 kg/m2. All subjects received the Altilix® supplement (150 mg/day) or placebo using a computer-based random allocation system. After six months of treatment Altilix® significantly reduced body weight, glycemic, and lipid parameters (total cholesterol, triglycerides, LDL-cholesterol) and improved hepatic functionality, CIMT, and FMD. In conclusion, these results confirm that Altilix® supplementation has a significant effect on cardiometabolic parameters not only in obese subjects but also in pre-obesity subjects.
... Table 4]. However, these results changed with the simultaneous use of aerobic exercise and natural products as follows: the effect of aerobic exercise and [74] natural products on the reduction of AST levels was obtained at -1.55 (CI95%: -2.85 to -0.24), ALT: -2.03 (CI95%: -3.70 to -0.36), GGT: -0.43 (CI95%: -1.24 to 0.38), and ALP: -0.04 (CI95%: -0.84 to 0.76). ...
Background:
Nonalcoholic fatty liver is the most common chronic liver disease. Regarding the side effects of synthetic medicines and the variety of natural products in Iran climate, the present study aimed to investigate the effect of medicinal plants and natural products on liver enzymes in patients with non-alcoholic fatty liver disease in Iran using meta-analysis.
Methods:
To extract the intended studies, internal and external databases, including SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, and Clinical Trial Registration System of Clinical trial.gov, the ISRCTN system, as well as Clinical Trial Registration System affiliated to the World Health Organization were searched. The obtained data were analyzed in STATA.14 software. A P value less than 0.05 was considered statistically significant.
Results:
A total of 44 rstudies were reviewed with a sample size of 1298 participant; they were published in the period from 2009 to 2018, silymarin had the highest effect on the reduction of AST (SMD = -2.68), cinnamon excreted the most profound effect on ALT (SMD = -2.69). In addition, cinnamon had the highest effect on gamma-glutamyl transferase (GGT) (SMD:-3.17), and curcumin had the highest effect on alkaline phosphatase (ALP) (SMD = -1.88). In the lipid profile, the effect of medicinal herbs and natural products on lowering total cholesterol and LDL was statistically significant. In the glycemic profile, the effect of medicinal plants and natural products on the reduction of fasting blood sugar, insulin, and hemoglobin A1c levels was statistically significant.
Conclusions:
As evidenced by the obtained results, the highest effect of using natural products was observed in the reduction of GGT, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, respectively; nonetheless, the effect of natural products on ALP reduction was not statistically significant.
... Studies have shown increased liver weight within 10 and 15 weeks of obesity induction [43]. In contrast, ultrasound findings demonstrated significant improvement in NASH severity in 81.6% of patients treated with artichoke extract (600 mg/day) versus placebo as well as a significant reduction in liver damage markers such as alanine aminotransferase and aspartate aminotransferase [44]. ...
This study aimed to evaluate the effect of Cynara cardunculus leaf ethanol extract on inflammatory and oxidative stress parameters in the hypothalamus, prefrontal cortex, hippocampus, striatum, cerebral cortex and liver of high-fat diet-induced obese mice. Food intake, body weight, visceral fat weight, and liver weight were also evaluated. Male Swiss mice were divided into control (low-fat purified diet) and obese (high-fat purified diet) groups. After 6 weeks, mice were divided into control + saline, control + C. cardunculus leaf ethanol extract, obese + saline, obese + C. cardunculus leaf ethanol extract. Cynara cardunculus leaf ethanol extract (1600 mg/kg/day) or saline was administered orally for 4 weeks. Brain structures (hypothalamus, hippocampus, prefrontal cortex, striatum and cerebral cortex) and liver were removed. Treatment with C. cardunculus leaf ethanol extract did not affect body weight but did reduce visceral fat. Obesity can cause inflammation and oxidative stress and increase the activity of antioxidant enzymes in brain structures. Treatment with ethanolic extract of C. cardunculus leaves partially reversed the changes in inflammatory damage parameters and oxidative damage parameters and attenuated changes in the antioxidant defense. The C. cardunculus leaf ethanol extract benefited from the brains of obese animals by partially reversing the changes caused by the consumption of a high-fat diet and the consequent obesity. These results corroborate those of studies indicating that the C. cardunculus leaf ethanol extract can contribute to the treatment of obesity.
... 5 The increasing incidence of NAFLD has been related to a dramatic change in dietary habits, notably an increase in consumption of fat and simple carbohydrates. 6 Rapidly increasing urbanization, mechanization and economic development of Africa and the world at large have resulted in a dietary transition from a traditional to a modernized diet (food in which the quality has been affected). Similarly, Ethiopia is also undergoing an epidemiologic transition mainly driven by demographic and lifestyle changes that promotes enormous changes in diets. ...
Introduction:
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent disease due to a dramatic change in dietary habits, especially an increase in consumption of fat and carbohydrates in deep-fried foods.
Objective:
The objective was to evaluate the effect of hydromethanolic seed extract of Lepidium sativum on deep-fried palm oil diet induced NAFLDon male mice.
Methods:
An experimental study design was conducted. Twenty-four male mice aged 8 to 10 weeks, weighing 32-42 g were divided into four groups. The four groups were divided into two controls and two treatments. Mice in normal control (C0) were administered only with the basal diet whereas negative control (C1) provided only with the deep-fried palm oil diet. The treatment groups T1, and T2 were administered with deep-fried palm oil diet and HMSELS at dose of 200 and 400 mg/kg/day, respectively for 28 days. Then on day 29, the mice were fasted overnight, anaesthetized and sacrificed by cervical dislocation after blood was taken by cardiac puncture for liver function tests while liver tissues were taken for histopathology investigation.
Results:
The serum ALT and total bilirubin showed significant decrement whereas the serum albumin levels showed significant increment in T2 group. However, serum AST and ALP levels were decreased significantly in both T1 and T2 groups. Besides, the T2 group liver sections of mice were showed better effect of HMSELS on restoring the damaged liver histopathology almost toward normal.
Conclusion:
The HMSELS at a dose of 400 mg/kg/day (T2) was more effective on the liver function tests and liver histopathology that altered by feeding deep-fried palm oil diet. The good protective effect of HMSELS against deep-fried palm oil diet-induced NAFLD might be due to its antioxidant content.
... Many studies have shown that artichoke leaf extract (ALE), rich in phenolic compounds and caffeic acid derivatives, provides a hepatoprotective effect by significantly preventing oxidative damage in hepatocyte membranes. It has been reported in many studies in the literature that ALE exhibits both nephroprotective and hepatoprotective properties in paracetamol and cadmium-induced toxicity [4][5][6][7] . ...
Objective:
The aim of this study was to evaluate the hepatoprotective effect and mechanism of action of artichoke leaf extract in hepatic ischemia/reperfusion injury.
Methods:
Rats were divided into three groups such as sham, control, and artichoke leaf extract groups. Antioxidant enzyme activities and biochemical parameters were examined from the tissue and serum obtained from the subjects. Histopathological findings were scored semiquantitatively.
Results:
Statistically, the antioxidant activity was highest in the artichoke leaf extract group, the difference in biochemical parameters and C-reactive protein was significant compared with the control group, and the histopathological positive effects were found to be significantly higher.
Conclusions:
As a result, artichoke leaf extract had a hepatoprotective effect and that this effect was related to the antioxidant and anti-inflammatory effects of artichoke.
... A doubleblind clinical trial in patients with non-alcoholic liver injury confirmed the results of preclinical studies. Patients receiving ALE 600 mg daily for 2 months had an increased hepatic vein flow, reduced portal vein diameter, and improved lipid and hepatic enzyme profiles (Panahi et al., 2018). Another trial investigated the efficacy of a standardized ALE in patients with chronic Hep C infection (Huber et al., 2009). ...
Humans used plants for thousand of years as food, drugs, or fuel to keep homes warm. People commonly used fruits and roots, and other parts of the plant were often wasted. This review aims to discuss the potential of rational stem-to-stern use of three highly versatile and valuable plants with hepatoprotective properties. Milk thistle (Silybum marianum L. Gaertn.), artichoke (Cynara cardunculus), and chicory (Cichorium intybus L.) have well-characterized hepatoprotective properties. These plants have been chosen since liver diseases are significant diseases of concern worldwide, and all parts of plants can be potentially utilized. Artichoke and chicory are commonly used as food or dietary supplements and less often as phytodrugs. Various dietary supplements and phytodrugs prepared from milk thistle (MT) fruits/seeds are well-known to consumers as remedies supporting liver functions. However, using these plants as functional food, farm animal feed, is not well-described in the literature. We also discuss bioactive constituents present in various parts of these plants, their pharmacological properties. Distinct parts of MT, artichoke, and chicory can be used to prepare remedies and food for humans and animals. Unused plant parts are potentially wasted. To achieve waste-free use of these and many other plants, the scientific community needs to analyze the complex use of plants and propose strategies for waste-free technologies. The government must stimulate companies to utilize by-products. Another problem associated with plant use as a food or source of phytodrug is the overharvesting of wild plants. Consequently, there is a need to use more active cultivation techniques for plants.
... The LC/MS analysis revealed metabolic signatures by regulating sixteen metabolites and altering two metabolic pathways (nicotinate and nicotinamide metabolism, fatty acid metabolism). ALT and AST are traditional liver markers, and the elevated serum levels indicated clear liver injury (26)(27)(28). In this study, serum AST and ALT levels increased between TI and CI after operation, but the augments of serum AST (P=0.01) and ALT (P=0.01) ...
Background:
Liver cancer as the main leading cancer has caused heavy burdens globally. The prognosis of liver cancer is closely related with postoperative nutrition support. Corn oligopeptides (COPs) are protein hydrolysates produced by enzymatic treatments, which have shown potential bioactivities, such as inhibiting angiotensin I-converting enzyme, resisting lipid peroxidation and anti-oxidant. However, the correlation between COPs and liver cancer patients is still unknown and the potential mechanism of COPs on liver cancer is unclear as well. The aim of this study was to assess effects of 7-day intervention of COPs after surgery on liver function and serum metabolic profiles of liver cancer patients.
Methods:
Patients were assigned into COPs intervention group (n=50) and control group (n=91) for 7 days. Investigations were scheduled at 1st day and 7th day after liver resection surgery respectively, mainly including anthropometric, biochemical indexes and liquid chromatography-mass spectrometry (LC/MS) analysis.
Results:
Seven-day supplementation of COPs on early post-surgery liver cancer patients down-regulated levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin and up-regulated prothrombin time activity and prealbumin levels. LC/MS analysis revealed metabolic signatures including regulation of 16 metabolites, which was closely related with two metabolic pathways (nicotinate and nicotinamide metabolism, fatty acid metabolism).
Conclusions:
COPs supplementation has displayed the potentials on alleviating the injury of liver function and it may be due to regulation of fatty acid metabolism, nicotinate and nicotinamide metabolism, lipid peroxidation and anti-inflammatory action. More researches are warranted in future to confirm the exact mechanisms.
... 34 Over the centuries, many populations have incorporated artichokes into their culture and food habits because of their efficacy and safety. 35 Pre-and clinical studies show that artichoke bud extract (ABE) has potential as a lipidlowering and hepatoprotective agent 36,37 due to the presence of powerful antioxidants. For instance, animal experiments indicated that these extracts elevate superoxide dismutase, catalase, glutathione, and glutathione peroxidase activities in the liver and lower the contents of malondialdehyde in the liver and plasma. ...
Hypertension adversely affects the quality of life in humans across modern society. Studies have attributed increased reactive oxygen species production to the pathophysiology of hypertension. So far, a specific drug to control the disease perfectly has not been developed. However, artichoke, an edible vegetable, plays an essential role in treating many diseases due to its potent antioxidant activities. The objective of this study is to evaluate the effect of artichoke bud extract (ABE) on heart tissue metabolomics of hypertensive rats. Spontaneously hypertensive rats and Wistar–Kyoto (WKY) rats were divided into six groups, then exposed to different doses comprising ABE, Enalapril Maleate, or 1% carboxylmethyl cellulose for 4 weeks. Their blood pressures were recorded at 0, 2, 3, and 4 weeks after the start of the test period. Thereafter, all rats were anesthetized, and blood was collected from their cardiac apexes. Then, we measured the levels for 15 kinds of serum biochemical parameters. An established orthogonal partial least square-discriminant analysis model completed the metabolomic analysis. Hypertensive rats in the ABE group exhibited well-controlled blood pressure, relative to those in the model group. Specifically, artichoke significantly lowered serum levels for total protein (TP), albumin (ALB), and uric acid (UA) in the hypertensive rats. This effect involved the action of eight metabolites, including guanine, 1-methylnicotinamide, p-aminobenzoic acid, NAD, NADH, uridine 5′-monophosphate, adenosine monophosphate, and methylmalonic acid. Collectively, these findings suggest that ABE may play a role in affecting oxidative stress and purine, nicotinate, and nicotinamide metabolism.
Introduction: Previous studies reported inconsistent results of the association between Helicobacter pylori (H. pylori) infection and nonalcoholic fatty liver disease (NAFLD). Methods: A cohort study of 2063 adults without NAFLD at baseline, who participated in a repeated health check-up including a 13C urea breath test and abdominal ultrasonography, was conducted to evaluate the link between H. pylori infection and NAFLD development. Results: During a mean follow-up period of 1.7 years, we did not found a significant association between H. pylori infection and NAFLD (Hazard ratio (HR) = 1.10 (0.86, 1.40), p = 0.4689). We also found that higher age, body mass index (BMI), systolic blood pressure (systolic BP), diastolic blood pressure (diastolic BP), fasting blood glucose, triglycerides, total cholesterol, low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were risk factors, and high density lipoprotein cholesterol (HDL-C) was a protective factor for NAFLD development. Conclusions: H. pylori infection might not be positively related to NAFLD development.
We have already published a review about the results of clinical trials evaluating the effects of selected nutraceuticals on glycemia in humans. In this second part, we describe the role of other nutraceuticals involved in dysglycemia. The available evidence showed promising hypoglycemic effects of the nutraceuticals reviewed both for their efficacy and safety profile. However, contradictory results as regard the efficacy of some supplements such as Allium sativum , Juglans regia , and Lycium barbarum on glucose homeostasis have emerged from some clinical studies. Other nutraceuticals including Aloe vera , Amorphophallus Konjac , Bauhinia forficata , Coccinia , Ganoderma lucidum , Ipomoea batatas , and Lupinus mutabilis require larger and long‐term studies rigorously designed to confirm their hypoglycemic effects due to the scarce data available and the poor quality of clinical trials. Further studies are also required for Cinnamomum , Cynara scolymus , Momordica charantia , Olea europaea , and Opuntia streptacantha . Moreover, well‐designed large and long‐term clinical trials including the use of standardized nutraceutical preparations are necessary for Phaseolus vulgaris and Vaccinium myrtillus .
The rising incidences and prevalence of metabolic diseases, creating enormous health and economic burden worldwide, are a global healthcare challenge. Such conditions, which can be inherited or acquired, are exemplified by type II diabetes, high blood pressure, dyslipidemia, non-alcoholic fatty liver disease, obesity, etc. and are caused by dysregulated metabolism, i.e. defects in the body’s energy processing system. Increase in mortality and years of healthy life lost due to metabolic diseases calls for urgent attention to manage these diseases. Current treatment options largely involve prolonged allopathic medication which is disadvantageous because of associated adverse health effects. Moreover, these diseases often occur as a constellation of maladies requiring complex treatment regimens with multiple drugs culminating in adverse drug-drug interactions. Therefore, considering the limitations of existing therapeutic options, there is a renewed and growing interest in the use of ethnomedicines for the management of metabolic diseases. Ethnomedicine offers advantage over allopathy or chemical drugs, because these are part of indigenous traditional knowledge system and hence are time-tested, safer, economically affordable, accessible and hence sustainable in the long run. In this chapter, we discuss about ethnomedicines which are used in the treatment and management of diabetes, obesity, dyslipidemia, hypertension, fatty liver diseases, etc. in various parts of the world. We also discuss about the scientific investigations that have been performed to validate the therapeutic potential of widely used ethnomedicines against metabolic diseases. Finally, clinical trials conducted on ethnomedicinal resources for the cure of metabolic disorders and associated drawbacks will be reported.
Objectives: This study aims to determine the awareness levels and factors affecting
it, along with prevalent misconceptions about Steatotic Liver Disease (SLD) among
participants with high‐risk indicators.
Methods: A questionnaire with open‐ended questions was utilized. Participants
were recruited from two general internal medicine outpatient clinics, focusing on
those with high‐risk indicators for SLD. Data collection involved a questionnaire
covering demographic information, self‐reported clinical conditions, and open‐ended
questions about SLD awareness. Key focus areas included misconceptions, thematic
awareness, and the relationship between awareness and educational attainment.
Results: The study involved 228 participants, predominantly female (70.4%), with an
average age of 53.8 years. Only 33.7% showed a comprehensive understanding of all
aspects of SLD. However, 90.4% provided some accurate information, though often
limited or incomplete. Higher education and awareness of SLD risks were key predictors
of better understanding. The logistic regression model, with an accuracy of 0.76 and
recall of 0.84, found higher education inversely related to low awareness. Common
misconceptions highlighted included the belief that polypharmacy or certain medications
cause SLD, fatigue as an effect, and increased water intake as a treatment. Notably,
seven patients mentioned artichoke consumption as a potential treatment.
Conclusion: The findings highlight the gap between comprehensive and partial
awareness of SLD among high‐risk individuals. Educational level and informed
understanding of SLD risks are crucial for improving awareness, emphasizing the
need for specialized educational efforts and risk communication to high‐risk patients.
Due to a scarcity of appropriate therapeutic approaches capable of ameliorating or eliminating non‐alcoholic fatty liver disease (NAFLD), many researchers have come to focus on natural products based on traditional medicine that can be utilized to successfully treat NAFLD. In this study, we aimed to evaluate the effects exerted by seven natural products (curcumin, silymarin, resveratrol, artichoke leaf extract, berberine, catechins, and naringenin) on patients with NAFLD. For this purpose, PubMed, Embase, Cochrane Library, and Web of Science, were searched for randomized controlled trials (RCTs) exclusively. The selected studies were evaluated for methodological quality via the Cochrane bias risk assessment tool, and data analysis software was used to analyze the data accordingly. The RCTs from the earliest available date until September 2022 were collected. This process resulted in 37 RCTs with a total sample size of 2509 patients being included. The results of the network meta‐analysis showed that artichoke leaf extract confers a relative advantage in reducing the aspartate aminotransferase (AST) levels (SUCRA: 99.1%), alanine aminotransferase (ALT) levels (SUCRA: 88.2%) and low‐density lipoprotein cholesterol (LDL‐C) levels (SUCRA: 88.9%). Naringenin conferred an advantage in reducing triglyceride (TG) levels (SUCRA: 97.3%), total cholesterol (TC) levels (SUCRA: 73.9%), and improving high‐density lipoprotein cholesterol (HDL‐C) levels (SUCRA: 74.9%). High‐density catechins significantly reduced body mass index (BMI) levels (SUCRA: 98.5%) compared with the placebo. The Ranking Plot of the Network indicated that artichoke leaf extract and naringenin performed better than the other natural products in facilitating patient recovery. Therefore, we propose that artichoke leaf extract and naringenin may exert a better therapeutic effect on NAFLD. This study may help guide clinicians and lead to further detailed studies.
The obesity epidemic has pushed fatty liver disease, which consists of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, to the forefront of the 21st century. Disease identification can be done invasively with a liver biopsy or noninvasively through elastography and measurements of biomarkers, such as the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) liver enzymes. Presently, there are no FDA-approved drugs on the market to treat the disease. Alternative medicinal treatments have been investigated, which include altering the intestinal microbiota and consuming anti-inflammatory, herbal-based, vitamin-based, and plant-based medications, in addition to following a healthy lifestyle. In this study, multiple databases were used to identify articles pertaining to fatty liver disease (FLD). Databases included Biomedical Reference Collection: Comprehensive, Cumulative Index of Nursing and Allied Health (CINAHL), Google Scholar, and PubMed. All articles gathered from the databases were peer-reviewed and less than 10 years old to ensure the credibility of the work and recent information regarding the disease. A total of 13 articles were used to gather information for this review. All articles were confirmed to be peer-reviewed by checking them with Ulrich’s web. In all 13 peer-reviewed articles, the diagnosis of FLD was most commonly done by analyzing ALT and AST liver enzymes and lipid profiles. Liver ultrasound, liver FibroScan, and liver biopsy served as other tools used for detecting the presence of FLD. It was observed that anti-inflammatory, herbal-based, vitamin-based, and plant-based medications and healthy gut microbiota had beneficial and therapeutic effects in treating FLD when coupled with healthy lifestyle changes. All medicinal treatments were found to lower the ALT and AST liver enzymes, lipid profiles (total cholesterol, triglycerides, low-density lipoprotein), and liver steatosis scores in studies where ultrasound was used before and after treatment. Further investigation is needed to fully understand the mechanisms behind the therapeutic effects of treating FLD; however, the medicinal treatments discussed in this review show promising prospects for treating the disease. The therapeutic effects of anti-inflammatory, herbal-based, vitamin-based, and plant-based medications and living a healthy lifestyle were seen in lower levels of liver enzymes, improved lipid profiles, and lower steatosis scores, with no reported side effects on subjects. The treatment options studied may have beneficial impacts in treating FLD patients and may be used in the development of future medications to combat the disease.
Non-alcoholic fatty liver disease [NAFLD] is a common metabolic disorder associated with obesity, diabetes mellitus, dyslipidemia and cardiovascular disease. A "multiple hit" model has been a widely accepted explanation for the disease's complicated pathogenesis. Despite advances in our knowledge of the processes underlying NAFLD, there is no conventional pharmaceutical therapy. The only currently approved option is to make lifestyle modifications, such as dietary and physical activity changes. The use of medicinal plants in the treatment of NAFLD has gained interest. Thus, we review the current knowledge about these agents based on clinical and preclinical studies. Moreover, the association between NAFLD and colorectal cancer [CRC], one of the most common and lethal malignancies, has recently emerged as a new study area. We overview the shared dysregulated pathways and the potential therapeutic effect of herbal medicines for CRC prevention in patients with NAFLD.
Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide. The etiology of NAFLD is highly heterogeneous, which occurs and develops under the joint action of metabolism, inflammation, genetics, environment, and gut microbiota. At present, the principal therapeutic modalities targeting NAFLD are lifestyle interventions such as weight loss through diet and exercise. At present, there is no established therapy for the treatment of NAFLD, and many therapies are associated with a variety of side effects. A great number of in vitro and in vivo experiments have indicated that there are many natural foods that have therapeutic potential for NAFLD. This review summarizes the natural foods and their mechanisms that were found in recent years, furthermore, provides further information relevant to the treatment of NAFLD.
Abstract Background The “multiple-hit” hypothesis is currently the most widely accepted theory for non-alcoholic fatty liver disease (NAFLD) pathogenesis. The present study aimed to investigate the effects of the water extract of artichoke (WEA) on NAFLD and its underlying mechanism. Methods Rats were fed a high-fat diet (HFD) for 8 weeks to induce NAFLD and then treated with WEA at three doses (0.4, 0.8, and 1.6 g/kg body weight, BW) for 8 weeks. At the end of the intervention, serum biochemical parameters, hepatic antioxidant capacity, hepatic levels of pro-inflammatory cytokines, liver histopathology, hepatic inflammatory gene and lipid metabolism gene expression, and Akt and p-Akt (S473) protein levels were determined. Results The body weight, liver weight, liver triglyceride (TG) and serum levels of TG, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, glucose, and insulin were all significantly reduced in the WEA-treated groups (0.8 and 1.6 g/kg BW) compared with the HFD group (P
Background and Purpose: Non-alcoholic fatty liver disease is the most common liver disease that is progressing and affects more than a quarter of the world's population. In this regard, researchers believe that exercise and herbal medicines with anti-lipid and antioxidant properties can be beneficial as supplementary therapy. Therefore, the aim of this study was to examine the effects of eight weeks aerobic training and artichoke distillate consumption on liver fat and serum levels of liver enzymes in women with non-alcoholic fatty liver. Materials and Methods: For this purpose, 24 obese or overweight volunteer women with non-alcoholic fatty liver with the mean age of 39.9±3.8 years, and mean weight of 75.4±12.1 kg, were randomly assigned into three groups of eight subjects: artichoke, aerobic, and control. Subjects in the aerobic group performed three sessions of aerobic exercises per week for eight weeks. The aerobic training program included 30 minutes of running with an intensity of 11 on the Borg scale rating of perceived exertion during the first week. Training duration increased to 45 minutes and the intensity increased to 13 from the fifth week of the aerobic training program, according to the principle of progressive overload. Subjects in the artichoke group received 180¬cc of the artichoke distillate per day (60cc after each meal). The control group performed no intervention during the study period. Blood sample and ultrasound sonography of the liver were performed 48 hours before and after the intervention to measure serum levels of Alanine Aminotransfer-ase, Aspartate Aminotransferase, lipid profile (total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein), and liver fat. Results: Results showed that liver fat levels were significantly decreased within the aerobic (P = 0.034) and the artichoke (P = 0.011) groups. However, there was no significant difference between the effectiveness of the aerobic training and artichoke distillate consumption (P = 0.393). Serum levels of Alanine Aminotrans-ferase and Aspartate Aminotransferase had significant decrement within the aerobic group (P = 0.016 and P = 0.028, respectively). The levels of these enzymes had non-significant decrement within the artichoke group (P = 0.080 and P = 0.172, respectively), and significant increments within the control group (P = 0.024 and P = 0.008, respectively). There were no significant changes in the lipid profile within the groups. Conclusion: Performing three sessions of aerobic training with moderate intensity per week for eight weeks or consumption of 60cc artichoke distillate after each meal could reduce the levels of liver fat in obese or overweight women with non-alcoholic fatty liver. In addition, these patients can use aerobic training to reduce the liver enzymes and the artichoke distillate to prevent the increase of these enzymes. However , artichoke distillate consumption or moderate-intensity aerobic training could not lead to improvement of the liver fat levels in two months, without following a healthy diet regimen or other medical treatments.
The organ systems are specialized tissues that perform discrete functions. They are vital and thus have interdependencies. For instance, the heart and renal system both need and influence each other. When deficiency requirements of health and damaging factors lead to a weakened state, then the beginning of disease commences. This is at first hypofunction, then disordered circulation and communication in that tissue or organ. This further leads to inflammation, immune involvement, and eventually, fibrosis and drastic decline of function. Therapy involves addressing deficient requirements of health. More specific therapy involves supporting biochemical function, hormetic stimulation in the low-dose zone, and whole person therapy. These all help to increase adaptive responses of the body. Alternatively and often in combination, there are ways to dampen maladaptive responses and even to introduce some measure of homeostasis by external means. This is why standard medical therapy can often be successful, as it can externally create a balance or at least dampen maladaptive responses. But this may not lead to healing if the body is severely depleted and dysregulated.KeywordsDysfunctionNaturopathic treatmentDiagnosisWhole person approaches
Artichoke (Cynara scolymus L., Asteraceae) is a prevalent cultivated plant frequently consumed in the Mediterranean Regions, the USA, and Africa. C. scolymus is used in folkloric medicine to treat hepatitis and hyperlipidemia and its diuretic and choleretic effects. Artichoke includes vitamins, minerals, phenolic components, prebiotics, and terpenoids. It has several biological activities, especially antihyperlipidemic, antispasmodic, antiaging, antioxidant, antimicrobial, hepatoprotective, choleretic, hypoglycemic, and anticancer features. In recent years, C. scolymus has been designed and used in various pharmaceutical forms. Clinical analyses have stated that extracts from artichokes may have recuperating characteristics to treat a variety of diseases.KeywordsCynara scolymusGlobe artichokeAsteraceaeHepatoprotective
Cardoon (Cynara cardunculus L.) is a Mediterranean plant and member of the Asteraceae family that includes three botanical taxa, the wild perennial cardoon (C. cardunculus L. var. sylvestris (Lamk) Fiori), globe artichoke (C. cardunculus L. var. scolymus L. Fiori), and domesticated cardoon (C. cardunculus L. var. altilis DC.). Cardoon has been widely used in the Mediterranean diet and folk medicine since ancient times. Today, cardoon is recognized as a plant with great industrial potential and is considered as a functional food, with important nutritional value, being an interesting source of bioactive compounds, such as phenolics, minerals, inulin, fiber, and sesquiterpene lactones. These bioactive compounds have been vastly described in the literature, exhibiting a wide range of beneficial effects, such as antimicrobial, anti-inflammatory, anticancer, antioxidant, lipid-lowering, cytotoxic, antidiabetic, antihemorrhoidal, cardiotonic, and choleretic activity. In this review, an overview of the cardoon nutritional and phytochemical composition, as well as its biological potential, is provided, highlighting the main therapeutic effects of the different parts of the cardoon plant on metabolic disorders, specifically associated with hepatoprotective, hypolipidemic, and antidiabetic activity.
Medicinal plants are widely used as a complementary therapy to treat complex diseases, such as nonalcoholic fatty liver disease (NAFLD). Therefore, this study was done to investigate the effect of co‐administration of artichoke leaf extract supplement (ALES) with conventional medicines on patients with NAFLD. The clinical trial was based on patients randomly divided into three groups involving metformin‐vitamin E (ME), metformin‐ALES (MA), and vitamin E‐ALES (EA). The effectiveness of treatment in the treated groups was evaluated using liver ultrasonography and biochemical markers. After 12 weeks of treatment, the results showed that the rate of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was significantly reduced within all the study groups (p < .05). Liver ultrasonographic findings revealed that the rate of fat accumulation in liver of patients was decreased significantly within all the study groups and it was increased in the subjects with grade 0 fatty liver (without fat accumulation) in the MA and EA groups by 23.3 and 17.2%, respectively. In summary, the results of the present study showed that the concomitant use of ALES with metformin and vitamin E can have beneficial effects on amelioration of complications in patients with NAFLD. However, larger‐scale clinical trial studies are required in this regard.
Artichoke is a component of the Mediterranean diet. Therefore, the aim of this meta-analysis was to determine if artichoke extract supplementation affected human lipid parameters. The search included PubMed-Medline, Scopus, Web of Science and Google Scholar databases up to March 28, 2017, to identify RCTs investigating the impact of artichoke extracts on plasma lipid levels. Quantitative data synthesis was performed using a random-effects model, with weighed mean difference (WMD) and 95% confidence interval (CI) as summary statistics. Meta-analysis of data from 9 trials including 702 subjects suggested a significant decrease in plasma concentrations of total cholesterol (WMD: −17.6 mg/dL, 95%CI: −22.0, −13.3, p<0.001), Low Density Lipoprotein-Cholesterol (LDL-C; WMD: −14.9 mg/dL, 95%CI: −20.4, −9.5, p = 0.011) and triglycerides (WMD: −9.2 mg/dL, 95%CI: −16.2, −2.1, p = 0.011). No significant alteration in plasma High Density Lipoprotein-Cholesterol (HDL-C) concentrations was observed (WMD: 1.0 mg/dL, 95%CI: −1.1, 3.1, p = 0.333). A significant association between the LDL-lowering effect of artichoke and baseline LDL-C concentrations (slope: −0.170; 95%CI: −0.288, 0.051; p = 0.005) was observed. Thus, supplementation with artichoke extract was associated with a significant reduction in both total and LDL-C, and triglycerides, suggesting that supplementation may be synergistic with lipid-lowering therapy in patients with hyperlipidemia.
Aims:
To appraise the clinical and genetic evidence that low-density lipoproteins (LDLs) cause atherosclerotic cardiovascular disease (ASCVD).
Methods and results:
We assessed whether the association between LDL and ASCVD fulfils the criteria for causality by evaluating the totality of evidence from genetic studies, prospective epidemiologic cohort studies, Mendelian randomization studies, and randomized trials of LDL-lowering therapies. In clinical studies, plasma LDL burden is usually estimated by determination of plasma LDL cholesterol level (LDL-C). Rare genetic mutations that cause reduced LDL receptor function lead to markedly higher LDL-C and a dose-dependent increase in the risk of ASCVD, whereas rare variants leading to lower LDL-C are associated with a correspondingly lower risk of ASCVD. Separate meta-analyses of over 200 prospective cohort studies, Mendelian randomization studies, and randomized trials including more than 2 million participants with over 20 million person-years of follow-up and over 150 000 cardiovascular events demonstrate a remarkably consistent dose-dependent log-linear association between the absolute magnitude of exposure of the vasculature to LDL-C and the risk of ASCVD; and this effect appears to increase with increasing duration of exposure to LDL-C. Both the naturally randomized genetic studies and the randomized intervention trials consistently demonstrate that any mechanism of lowering plasma LDL particle concentration should reduce the risk of ASCVD events proportional to the absolute reduction in LDL-C and the cumulative duration of exposure to lower LDL-C, provided that the achieved reduction in LDL-C is concordant with the reduction in LDL particle number and that there are no competing deleterious off-target effects.
Conclusion:
Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.
Background . High HDL-cholesterol (HDL-C) values are negatively correlated with cardiovascular diseases. This review analyses the effect of the supplementation with various Mediterranean diet products (artichoke, bergamot, and olive oil) and Asian diet products (red yeast rice) on the HDL-C value in dyslipidemic subjects. Methods . A systematic review has been done involving all the English written studies published from the 1st of January 1958 to the 31st of March 2016. Results . The results of this systematic review indicate that the dietary supplementation with red yeast rice, bergamot, artichoke, and virgin olive oil has promising effects on the increase of HDL-C serum levels. The artichoke leaf extract and virgin olive oil appear to be particularly interesting, while bergamot extract needs further research and the effect of red yeast rice seems to be limited to patients with previous myocardial infarction. Conclusions . Various MediterrAsian diet products or natural extracts may represent a potential intervention treatment to raise HDL-C in dyslipidemic subjects.
Non-alcoholic fatty liver disease (NAFLD) is a global health problem. Although many aspects of NAFLD pathogenesis have been understood, there is a paucity of effective treatments to be used as the second line when lifestyle modification is insufficient. Curcumin, a natural polyphenol from turmeric, has been shown to be effective against development of hepatic steatosis and its progression to steatohepatitis, yet these beneficial effects have not been explored in clinical practice. The aim of this study is to investigate the effects of curcumin on hepatic fat content as well as biochemical and anthropometric features of patients with NAFLD. In this randomized double-blind placebo-controlled trial, patients with ultrasonographic evidence of NAFLD were randomly assigned to receive an amorphous dispersion curcumin formulation (500 mg/day equivalent to 70-mg curcumin) or matched placebo for a period of 8 weeks. Liver fat content (assessed through ultrasonography), glycemic and lipid profile, transaminase levels, and anthropometric indices were evaluated at baseline and at the end of follow-up period. The clinical trial protocol was registered under the Iranian Registry of Clinical Trials ID: IRCT2014110511763N18. Compared with placebo, curcumin was associated with a significant reduction in liver fat content (78.9% improvement in the curcumin vs 27.5% improvement in the placebo group). There were also significant reductions in body mass index and serum levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, glucose, and glycated hemoglobin compared with the placebo group. Curcumin was safe and well tolerated during the course of trial. Findings of the present proof-of-concept trial suggested improvement of different features of NAFLD after a short-term supplementation with curcumin. Copyright © 2016 John Wiley & Sons, Ltd.
Jerusalem artichoke (JA) has the potential to attenuate lipid disturbances and insulin resistance (IR), but the underlying mechanisms are not well understood. In the present study, we elucidated the physiological responses and mechanisms of JA intervention with a comprehensive transcriptome analysis. Wistar rats were fed a control diet, a 60 % fructose-enriched diet (FRU), or a FRU with 10 % JA (n 6-7) for 4 weeks. An oral glucose tolerance test was carried out on day 21. Liver samples were collected for biochemical and global gene expression analyses (GeneChip® Rat Genome 230 2.0 Array, Affymetrix). Fructose feeding resulted in IR and hepatic TAG accumulation; dietary JA supplementation significantly improved these changes. Transcriptomic profiling revealed that the expression of malic enzyme 1 (Me1), associated with fatty acid synthesis; decorin (Dcn), related to fibrosis; and cytochrome P450, family 1, subfamily a, polypeptide 2 (Cyp1a2) and nicotinamide phosphoribosyltransferase (Nampt), associated with inflammation, was differentially altered by the FRU, whereas dietary JA supplementation significantly improved the expression of these genes. We established for the first time the molecular mechanisms driving the beneficial effects of JA in the prevention of type 2 diabetes and non-alcoholic fatty liver disease. We propose that 10 % JA supplementation may be beneficial for the prevention of the onset of these diseases.
& Aims: Some patients with nonalcoholic fatty liver disease (NAFLD) develop liver-related complications and have higher mortality than other patients with NAFLD. We determined the accuracy of simple, non-invasive scoring systems in identification of patients at increased risk for liver-related complications or death.
We performed a retrospective, international, multicenter cohort study of 320 patients diagnosed with NAFLD, based on liver biopsy analysis, through 2002 and followed through 2011. Patients were assigned to mild, intermediate, or high-risk groups based on cut-off values for 2 of the following: NAFLD fibrosis score, aspartate aminotransferase/platelet ratio index (APRI), FIB-4 score, and BARD score. Outcomes included liver-related complications and death or liver transplantation. We used multivariate Cox proportional hazard regression analysis to adjust for relevant variables and calculate adjusted hazard ratios (aHRs) RESULTS: During a median follow-up period of 104.8 months (range 3-317 months), 14% of patients developed liver-related events, and 13% died or underwent liver transplantation. The aHRs for liver-related events in the intermediate and high-risk groups, compared to the low-risk groups, were 7.7 (95% confidence interval [CI], 1.4-42.7) and 34.2 (95% CI, 6.5-180.1), respectively, based on NAFLD fibrosis score; 8.8 (95% CI, 1.1-67.3) and 20.9 (95% CI, 2.6-165.3) based on the APRI; and 6.2 (95% CI, 1.4-27.2) and 6.6 (95% CI, 1.4-31.1) based on the BARD score. The aHRs for death or liver transplantation in the intermediate and high-risk groups, compared to the low risk groups, were 4.2 (95% CI, 1.3-13.8) and 9.8 (95% CI, 2.7-35.3), respectively, based on the NAFLD fibrosis scores. Based on APRI and FIB-4 scores, only the high-risk group had a greater risk of death or liver transplantation (aHR, 3.1; 95% CI, 1.1-8.4 and aHR, 6.6; 95% CI, 2.3-20.4, respectively).
Simple non-invasive scoring systems help identify patients with NAFLD who are at increased risk for liver-related complications or death. NAFLD fibrosis score appears to be the best indicator of patients at risk, based on hazard ratios. The results of this study require external validation.
The aim of this study was to evaluate the effects of artichoke leaf extract (ALE) supplementation (250 mg, 2 b.i.d.) on the lipid pattern. A randomized, double-blind, placebo-controlled clinical trial was performed on 92 overweight subjects with primary mild hypercholesterolaemia for 8 weeks. Forty-six subjects were randomized to supplementation (age: 54.2 ± 6.6 years, body mass index (BMI): 25.8 ± 3.9 kg/m(2), male/female: 20/26) and 46 subjects to placebo (age: 53.8 ± 9.0 years, BMI: 24.8 ± 1.6 kg/m(2), male/female: 21/25). Verum supplementation was associated with a significant increase in mean high-density lipoprotein (HDL)-cholesterol (p < 0.001) and in mean change in HDL-cholesterol (HDL-C) (p = 0.004). A significantly decreased difference was also found for the mean change in total cholesterol (p = 0.033), low-density lipoprotein (LDL)-cholesterol (p < 0.001), total cholesterol/HDL ratio (p < 0.001) and LDL/HDL ratio (p < 0.001), when verum and placebo treatment were compared. These results indicate that ALE could play a relevant role in the management of mild hypercholesterolaemia, favouring in particular the increase in HDL-C, besides decreasing total cholesterol and LDL-cholesterol.
Patients with nonalcoholic fatty liver disease (NAFLD) often have dyslipidemia along with other features of metabolic syndrome such as obesity, diabetes mellitus, and hypertension. The dyslipidemia in NAFLD is characterized by increased serum triglycerides, increased small, dense low-density lipoprotein (LDL nontype A) particles, and low high-density lipoprotein (HDL) cholesterol. The pathogenesis of dyslipidemia in NAFLD is not well understood, but it is likely related to hepatic overproduction of the very low-density lipoprotein particles and dysregulated clearance of lipoproteins from the circulation. There is unequivocal evidence that cardiovascular disease is the most common cause of mortality in patients with NAFLD. Aggressive treatment of dyslipidemia plays a critical role in the overall management of patients with NAFLD. Statins are the first-line agents to treat high cholesterol and their dosage should be adjusted based on achieving therapeutic targets and tolerability. Although all statins appear to be effective in improving cholesterol levels in patients with NAFLD, there is more experience with atorvastatin in patients with NAFLD; furthermore, it is the only statin to date to show a reduced cardiovascular morbidity in patients with NAFLD. The risk for serious liver injury from statins is quite rare and patients with NAFLD are not at increased risk for statin hepatotoxicity. Omega-3 fatty acids are perhaps the first choice to treat hypertriglyceridemia because of their safety, tolerability, and efficacy in improving serum triglycerides, as well as their potential to improve liver disease.
Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases and its prevalence is likely to reach epidemic proportions. According to the "two-stage hypothesis" proposed for the pathophysiology of NAFLD, insulin resistance, oxidative stress and pro-inflammatory cytokines are among the key promoters of the disease. Here, ginger has been hypothesized to prevent NAFLD or blunt its progression via several mechanisms, such as sensitizing insulin effects, activating peroxisome proliferator-activated receptor γ which induces adiponectin and down-regulates pro-inflammatory cytokines, changing the balance between adiponectin and tumor necrosis factor-α in favor of adiponectin, promoting considerable antioxidant effects and antidyslipidemic properties, and reducing hepatic triglyceride content which can prevent steatosis. The aforementioned mechanisms imply that ginger possesses interesting potentials for serving as a natural supplement for the prevention and treatment of NAFLD. Therefore, conducting trials to explore its benefits in clinical practice is greatly recommended.
Increased prevalence of abnormal aminotransferase levels and/or ultrasonographic evidence of hepatic steatosis (HS) have been found in women with polycystic ovary syndrome (PCOS). However, factors associated with non-alcoholic fatty liver disease (NAFLD) in PCOS are still under investigation. The aim of this case-control study was to investigate the presence of NAFLD and to assess factors associated with this condition in PCOS patients.
A prospective study of 57 premenopausal PCOS patients and 60 age- and weight-matched control women, with a history of no or minimal alcohol consumption was conducted. Anthropometric variables, biochemical and hormonal parameters were determined and NAFLD was evaluated by abdominal ultrasonography and biochemical testing, after excluding causes of secondary liver disease. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and free androgen index (FAI) was calculated.
PCOS patients had an increased prevalence of HS [21/57 patients (36.8%) versus 12/60 controls (20.0%), P < 0.05] and abnormal (> or =40 IU/l) serum aminotransferase levels [13/57 patients (22.8%) versus 2/60 controls (3.3%), P < 0.01] than controls. All patients and controls with metabolic syndrome had HS. Factors associated with HS were PCOS diagnosis, older age, increased BMI, waist circumference (WC), HOMA-IR and FAI values and decreased high-density lipid cholesterol and sex hormone binding globulin levels. PCOS patients had an OR of 3.55 (95% CI: 1.02-5.35) for HS versus controls, after adjustment for age, BMI and WC.
NAFLD is common in PCOS patients and increased androgen bioavailability may be implicated, in combination with metabolic abnormalities. Liver evaluation is proposed in PCOS patients, especially in those with metabolic syndrome.
Chronic hepatitis C (CHC) is one of the most important causes of chronic liver disease in the world, potentially resulting in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Liver biopsy is currently performed before therapy indication. Although, it is the golden standard there are many reasons to avoid or delay the procedure. APRI Score is an easy, low cost and practice alternative method which was described as an alternative for assessing structural changes in chronic hepatitis C (CHC). The rationale of this study was to observe the accuracy of APRI Score in comparison to liver biopsy in 400 patients divided into two groups of 200 carriers (Validation and Experimental groups respectively) selected at random or according to liver fibrosis staging (METAVIR). The ROC curves showed a concordance among these two methods of 92% and 88.5% when 1.05 was the cut off (F3 and F4), and 87% and 83%, on 0.75 cut offs (F2-F4). The discordance in advanced fibrosis staging (F3 and F4) was only 16 (8%) and 22 (11%) out of 200 patients in the experimental and validation groups, respectively. In 26 (13%) out of 200 patients in the experimental group and 34 (17%) out of 200 patients in the validation group, there was discordance between APRI Score and liver biopsy in moderate and advanced fibrosis (F2-F4). In conclusion APRI is a serological marker that has satisfactory sensitivity and specificity together with a high predictive value and it can be useful either in the absence of a biopsy or to reduce the frequency with which biopsies need to be carried out to monitor the evolution of chronic hepatitis C and the right moment for treatment indication.
Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver diseases, and is closely related to metabolic syndrome and its related conditions, diabetes mellitus and dyslipidemia. On the other hand, NAFLD as a multisystem disease increases the risk of several chronic diseases include type 2 diabetes mellitus, cardiovascular disease (CVD), and chronic kidney disease. The main objective was to review the efficacy of bioactive natural compounds assessed by clinical trials. Search literature using four databases (PubMed, EBSCO, Web of Science, and Ovid Medline) to review publications that focused on the impact of bioactive natural compounds in NAFLD treatment. Due to the lack of effective pharmacological treatments available for NAFLD, lifestyle modifications such as following a healthy diet, vigorous physical activity, and weight reduction remain the first line of treatment for NAFLD. However, due to the poor adherence to this type of treatment, especially for long-term weight loss diets some of which may have harmful effects on the liver, finding novel therapeutic agents for NAFLD treatment and/or preventing NAFLD progression has garnered significant interest. Although the therapeutic agents of NAFLD treatment have been reviewed previously, to date, no summary has been conducted of clinical trials examining the effects of herbal compounds on NAFLD-related biomarkers. This review highlights the beneficial role of herbal bioactives and medicinal plants in NAFLD treatment, particularly as complementary to a healthy lifestyle. All natural products described in this review seem to have some benefits to improve oxidative stress, cellular inflammation and insulin-resistance, which always remain as the "primum movens" of NAFLD pathogenesis.
Objective
Non-alcoholic fatty liver disease (NAFLD) is a common liver disease characterized by excess lipid deposition in the hepatic tissue and subsequent oxidative and inflammatory damage. Curcumin is a dietary polyphenol with lipid-modifying, antioxidant and anti-inflammatory properties. This study aimed to evaluate the efficacy and safety of supplementation with phytosomal curcumin in subjects with NAFLD.
Methods
Patients diagnosed with NAFLD (grades 1–3 according to liver ultrasonography) were randomly assigned to the curcumin (phytosomal form; 1 000 mg/day in 2 divided doses) (n=50) or placebo group (n=52) for a period of 8 weeks. All patients received dietary and lifestyle advises before the start of trial. Anthropometric measurements, hepatic enzymes, and liver ultrasonography were assessed at baseline and after 8 weeks of follow-up.
Results
87 subjects (n=44 and 43 in the curcumin and control group, respectively) completed the trial. Supplementation with curcumin was associated with a reduction in body mass index (−0.99±1.25 vs. − 0.15±1.31 in the curcumin and placebo groups, respectively; p=0.003) and waist circumference (−1.74±2.58 vs. −0.23±3.49 in the curcumin and placebo groups, respectively; p=0.024). Ultrasonographic findings were improved in 75.0% of subjects in the curcumin group, while the rate of improvement in the control group was 4.7% (p<0.001). Serum levels of aspartate aminotransferase and alanine aminotransferase were reduced by the end of trial in the curcumin group (p<0.001) but elevated in the control group (p<0.001). Curcumin was safe and well tolerated during the course of trial.
Conclusion
Short-term supplementation with curcumin improves liver fat and transaminase levels in patients with NAFLD.
At present, there is no evidence based pathway to stratify risk of chronic liver disease in a general population setting. Non-invasive tests of liver fibrosis may provide a mechanism for earlier diagnosis. These tests have been extensively validated in the hospital setting but their performance in a general population setting is unclear. We performed a systematic review of non-invasive tests used to stratify patients at risk of clinically significant liver disease in a general population setting and report the prevalence of chronic liver disease as defined by these tests. We systematically searched EMBASE, MEDLINE, Web of Science, reference lists from the original studies and recent conference proceedings. All study designs were considered. Nineteen studies were identified, utilising eleven non-invasive tests. Only transient elastography and Fibrotest were compared against histological end-points. The prevalence of liver fibrosis varied between 0.7% and 25.7%. More focussed stratification for advanced liver fibrosis (0.9%-2%) or cirrhosis (0.1%-1.7%) narrowed estimates of prevalence. Studies targeting patients with liver disease risk factors such as hazardous alcohol use or type 2 diabetes reported higher prevalence of advanced liver fibrosis (0%-27.9%) and cirrhosis (2.4%-4%). Validated non-invasive tests of liver fibrosis consistently detected otherwise unrecognised liver disease in the general population. Studies targeting risk factors found cirrhosis in 2.4 to 4 % of their target populations. Reliance on abnormal liver function tests will miss the majority of patients with significant liver injury. New pathways to stratify chronic liver, using non-invasive markers of liver fibrosis, are needed in the general population setting.
Large-scale epidemiological studies firmly established the association between low plasma levels of high-density lipoprotein-cholesterol (HDL-C) and elevated risk of cardiovascular disease. This relationship is thought to reflect the key biological function of HDL, which involves reverse cholesterol transport from the arterial wall to the liver for further excretion from the body. Other aspects of the cardioprotective HDL functionality include antioxidative, anti-inflammatory, anti-apoptotic, anti-thrombotic, vasodilatory, anti-infectious and anti-diabetic activities. Over the last decades, wide interest in HDL as an athero- and cardioprotective particle has resulted in the development of HDL-C raising as a therapeutic approach to reduce cardiovascular risk. Several strategies to increase circulating HDL-C concentrations were developed that primarily included use of niacin and fibrates as potent HDL-C raising agents. In the statin era, inhibition of cholesteryl ester transfer protein, infusion of artificially reconstituted HDL and administration of apolipoprotein A-I mimetics were established as other approaches to raise HDL-C. More recently, novel strategies targeting HDL metabolism, such as upregulation of apolipoprotein A-I production by the liver, were added to the list of HDL therapeutics. This review summarises current knowledge of HDL-targeting therapies and discusses perspectives of their use.
Nonalcoholic fatty liver disease (NAFLD) is the most common type of liver disease. NAFLD is considered a multifactorial disease and a clinically relevant hepatic manifestation of metabolic syndrome. NAFLD is often accompanied by a constellation of metabolic and non-metabolic alterations, like dyslipidemia, insulin resistance in the liver and peripheral tissues, inflammation and oxidative stress; therefore, treatment of NAFLD should be directed at correcting all of these disturbances. The natural polyphenol curcumin has been the subject of increasing research for the treatment of NAFLD due to its lipid-modifying, antioxidant, anti-inflammatory, insulin-sensitizing, anti-steatotic, and anti-fibrotic properties. The therapeutic efficacy of curcumin has been demonstrated in several experimental models of NAFLD, however, clinical evidence is still scarce. The present review summarizes the current knowledge on the impact of curcumin supplementation on different biochemical and histopathological features of NAFLD.
Given the high prevalence and rising incidence of non-alcoholic fatty liver disease (NAFLD), the absence of approved therapies is striking. Although the mainstay of treatment of NAFLD is weight loss, it is hard to maintain, prompting the need for pharmacotherapy as well. A greater understanding of disease pathogenesis in recent years was followed by development of new classes of medications, as well as potential repurposing of currently available agents. NAFLD therapies target four main pathways. The dominant approach is targeting hepatic fat accumulation and the resultant metabolic stress. Medications in this group include peroxisome proliferator-activator receptor agonists (eg, pioglitazone, elafibranor, saroglitazar), medications targeting the bile acid-farnesoid X receptor axis (obeticholic acid), inhibitors of de novo lipogenesis (aramchol, NDI-010976), incretins (liraglutide) and fibroblast growth factor (FGF)-21 or FGF-19 analogues. A second approach is targeting the oxidative stress, inflammation and injury that follow the metabolic stress. Medications from this group include antioxidants (vitamin E), medications with a target in the tumour necrosis factor α pathway (emricasan, pentoxifylline) and immune modulators (amlexanox, cenicriviroc). A third group has a target in the gut, including antiobesity agents such as orlistat or gut microbiome modulators (IMM-124e, faecal microbial transplant, solithromycin). Finally, as the ongoing injury leads to fibrosis, the harbinger of liver-related morbidity and mortality, antifibrotics (simtuzumab and GR-MD-02) will be an important element of therapy. It is very likely that in the next few years several medications will be available to clinicians treating patients with NAFLD across the entire spectrum of disease.
Background:
Non-alcoholic fatty liver disease (NAFLD) is one of the most common hepatic diseases in the general adult population. Dyslipidemia, hyperuricemia and insulin resistance are common risk factors and accompanying features of NAFLD. Curcumin is a dietary natural product with beneficial metabolic effects relevant to the treatment of NAFLD.
Aim:
To assess the effects of curcumin on metabolic profile in subjects with NAFLD.
Methods:
Patients diagnosed with NAFLD (grades 1-3; according to liver sonography) were randomly assigned to curcumin (1000 mg/day in two divided doses) (n=50) or control (n=52) group for a period of 8 weeks. All patients received dietary and lifestyle advises before the start of trial. Anthropometric measurements, lipid profile, glucose, insulin, glycated hemoglobin, and uric acid concentrations were measured at baseline and after 8 weeks of follow-up.
Results:
Eighty-seven subjects (n=44 and 43 in the curcumin and control group, respectively) completed the trial. Supplementation with curcumin was associated with a reduction in serum levels of total cholesterol (p<0.001), LDL-C (p<0.001), triglycerides (p<0.001), non-HDL-C (p<0.001) and uric acid (p<0.001); while serum levels of HDL-C and glucose control parameters remained unaltered. Curcumin was safe and well tolerated during this study.
Conclusion:
Results of the present trial suggest that curcumin supplementation reduces serum lipids and uric acid concentrations in patients with NAFLD.
Artichoke (Cynara scolymus) leaf extract was one of the few herbal remedies which the clinical and experimental trials have complemented each other. Both experimental and clinical effects have been verified through extensive biomedical herbal remedy research. Specifically, antioxidant, choleretic, hepatoprotective, bile-enhancing and lipid-lowering effects have been demonstrated, which corresponded with its historical use. Ongoing research seems to indicate that artichoke indeed have medicinal qualities. Most significant appears to be its beneficial effect on the liver. In animal studies, liquid extracts of the roots and leaves of artichoke have demonstrated an ability to protect the liver, with possibly even to help liver cells regenerate. Although research is not yet conclusive, scientists were optimistic that its long-standing use in humans for digestive and bowel problems was indeed justified. It may also play a role in lowering cholesterol and thus help to prevent heart disease. Boiled wild artichoke reduced postprandial glycemic and insulinemic responses in normal subjects but has no effect on metabolic syndrome patients. This article intended to review the wide ranging pharmacological effects of artichoke leaf extract.
Background/aims:
To investigate the advantage of Chlorella vulgaris supplementation as an adjunctive therapy in patients with non-alcoholic fatty liver disease (NAFLD).
Methodology:
In a randomized, open-label clinical trial, 76 individuals with NAFLD were randomly assigned to: 1) Chlorella group (n=33), receiving C. vulgaris extract (1200 mg/day) + metformin (750 mg/ day) + vitamin E (200 mg/day) for 3 months, or 2) Metformin group (n=43), receiving metformin (1250 mg/ day) + vitamin E (200 mg/day) for 3 months. Weight, body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) index as well as serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), insulin, total and direct bilirubin, fasting blood sugar (FBS), glycated hemoglobin (HbA1c), uric acid, albumin and lipid profile were evaluated at baseline and at the end of trial.
Results:
Weight and BMI were decreased in both groups. Serum ALT, AST, triglycerides, uric acid, HbA1c and HOMA-IR index were reduced only in the Chlorella group whereas significant changes in total cholesterol, LDL, HDL and FBS were only observed in the metformin group. There were also borderline significant reductions in insulin and FBS in the Chlorella group.
Conclusions:
The findings of the present trial indicated that addition of C. vulgaris extract to the therapeutic regimen of NAFLD including metformin and vitamin E, is associated with favorable effects on serum levels of transaminases, triglycerides as well as insulin sensitivity. Therefore, C. vulgaris extract might be a promising hepatoprotective supplement for patients with NAFLD.
Several studies investigated the effect of pioglitazone and rosiglitazone on aminotransferases and liver histology in adults with NASH. In an early uncontrolled open-label study117 in 22 subjects with biopsy-proven NASH, rosiglitazone improved aminotransferases and hepatic steatosis, ballooning and inflammation scores, but not fibrosis. But in a subsequent RCT, Ratziu et al.118 observed that rosiglitazone improved aminotransferases and hepatic steatosis, but not necroinflammation or fibrosis and its two-year open-label extension phase also showed similar results.119 Belfort et al.120 conducted a RCT of pioglitazone (45 mg/day) in patients with NASH who had impaired glucose tolerance or T2DM. Although there was a significant weight gain (2.5 ± 0.5 kg) with pioglitazone, it significantly improved aminotransferases, steatosis, ballooning, and inflammation. The NAS improved with pioglitazone in 73% compared to 24% of placebo-treated patients (P
A study was conducted in hamsters to determine if artichoke leaf extract (ALE) could lower plasma total and non-HDL cholesterol by increasing fecal excretion of neutral bile acids and sterols. Sixty-four Golden Syrian hamsters (8 week old) were fed control diet or a similar diet containing ALE (4.5 g/kg diet) for 6 weeks. No significant changes for total cholesterol, HDL, non-HDL cholesterol triglycerides or fecal neutral sterols and bile acids were found after 21 days for ALE-fed animals compared with controls. But after 42 days, ALE-fed male hamsters had significantly lower total cholesterol (15%), non-HDL cholesterol (30%) and triglycerides (22%) and female hamsters fed ALE showed reductions of 15% for total cholesterol, 29% for non-HDL cholesterol and 29% for triglycerides compared with controls. Total neutral sterol and bile acids concentrations increased significantly by 50% and 53% in fecal samples of ALE fed males, and 82.4% and 25% in ALE fed females compared with controls. The ALE lowered hamster plasma cholesterol levels by a mechanism involving the greater excretion of fecal bile acids and neutral sterols after feeding for 42 days.
Non-alcoholic fatty liver disease (NAFLD), the most common liver disorder in the Western world, is a clinico-histopathological entity in which excessive triglyceride accumulation in the liver occurs. Non-alcoholic steatohepatitis (NASH) represents the necroinflammatory form, which can lead to advanced liver fibrosis, cirrhosis, and hepatocellular carcinoma. The pathogenesis of NAFLD/NASH is complex but increased visceral adiposity plus insulin resistance with increased free fatty acids release play an initial key role for the onset and perpetuation of liver steatosis. Further events in the liver include oxidative stress and lipid peroxidation, decreased antioxidant defences, early mitochondrial dysfunction, iron accumulation, unbalance of adipose-derived adipokines with a chronic proinflammatory status, and gut-derived microbial adducts. New gene polymorphisms increasing the risk of fatty liver, namely APOC3 and PNPLA3, have been lately identified allowing further insights into the pathogenesis of this condition. In our review pathophysiological, genetic, and essential diagnostic and therapeutic aspects of NAFLD are examined with future trends in this field highlighted.
We develop the idea of using data from the first 'few' patients entered in a clinical trial to estimate the final trial size needed to have specified power for rejecting H0 in favour of H1 if a real difference exists. When comparing means derived from Normally distributed data, there is no important effect on test size, power or expected trial size, provided that a minimum of about 20 degrees of freedom are used to estimate residual variance. Relative advantages and disadvantages of using larger internal pilot studies are presented. These revolve around crude expectations of the final study size, recruitment rate, duration of follow-up and practical constraints on the ability to prevent the circulation of unblinded randomization codes to investigators and those involved in editing and checking data.
High-dose aqueous extracts from artichoke leaves were found to inhibit cholesterol biosynthesis from (14)C-acetate rather moderately in HepG2 cells in contrast to primary cultured rat hepatocytes in which the inhibition was stronger. Preincubation of the extracts with several glycohydrolases revealed that pretreatment with beta-glucosidase considerably reinforced the inhibition. A significant reduction of acetate incorporation was found above extract concentrations of 0.01 mg/mL and at 0.2 mg/mL almost 60% inhibition was observed. Cytotoxic effects detected by the MTT-assay were restricted to higher concentrations of the extracts with and without beta-glucosidase pretreatment. Since cynaroside represents a major glucoside in artichoke extracts, both cynaroside and its aglycone luteolin were tested. It could be demonstrated that cynaroside is indeed one of the targets of beta-glucosidase and that the liberated luteolin is responsible for the inhibitory effect. Direct measurements of beta-glucosidase activity in rat hepatocytes and HepG2 cells revealed that endogenous enzyme activity in hepatocytes may be sufficient to convert cynaroside to its aglycone, while in HepG2 cells this may not be the case. These findings emphasize the importance of beta-glucosidase-dependent liberation of luteolin for the ability of artichoke extracts to inhibit hepatic cholesterol biosynthesis.
Information on the stage of liver fibrosis is essential in managing chronic hepatitis C (CHC) patients. However, most models for predicting liver fibrosis are complicated and separate formulas are needed to predict significant fibrosis and cirrhosis. The aim of our study was to construct one simple model consisting of routine laboratory data to predict both significant fibrosis and cirrhosis among patients with CHC. Consecutive treatment-naive CHC patients who underwent liver biopsy over a 25-month period were divided into 2 sequential cohorts: training set (n = 192) and validation set (n = 78). The best model for predicting both significant fibrosis (Ishak score > or = 3) and cirrhosis in the training set included platelets, aspartate aminotransferase (AST), and alkaline phosphatase with an area under ROC curves (AUC) of 0.82 and 0.92, respectively. A novel index, AST to platelet ratio index (APRI), was developed to amplify the opposing effects of liver fibrosis on AST and platelet count. The AUC of APRI for predicting significant fibrosis and cirrhosis were 0.80 and 0.89, respectively, in the training set. Using optimized cut-off values, significant fibrosis could be predicted accurately in 51% and cirrhosis in 81% of patients. The AUC of APRI for predicting significant fibrosis and cirrhosis in the validation set were 0.88 and 0.94, respectively. In conclusion, our study showed that a simple index using readily available laboratory results can identify CHC patients with significant fibrosis and cirrhosis with a high degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among CHC patients.
We aimed to define nonalcoholic steatohepatitis (NASH) histopathological change over time and to correlate changes with clinical characteristics.
We retrieved nonalcoholic fatty liver cases from our histopathology database covering 1985 to 2001. We also identified patients in clinic with NASH on biopsy >1 yr prior. All patients were evaluated and clinical data obtained in clinic. Those patients qualifying for NASH therapeutic trials underwent liver biopsy pretreatment. One pathologist (S.T.) read all slides using a NASH grading and staging system.
A total of 22 patients had repeat biopsies a mean of 5.7 yr (range 1.4-15.7 yr) after the first biopsy. Nine were women, nine had diabetes, 11 had hypertension, and 14 had hyperlipidemia. Mean body mass index was 33.8 kg/m(2) (range 26.5-48.6 yr). Mean age was 50.6 yr (range 33-64 yr). Ten patients (45%) had fibrosis stage 1 or 2, and two patients (9%) had bridging fibrosis or cirrhosis (stage 3 or 4) on first biopsy. Seven (32%) had increases in fibrosis score. Four patients (18%) had decreases in fibrosis score. The percentage of patients with stage 3 or 4 increased from 9% to 18%. In two patients the disease progressed rapidly (fibrosis scores from 1 to 3 in 1.4 yr and from 2 to 4 in 2.6 yr). Only serum AST at last biopsy correlated with histological change, being higher in those with disease progression. Three patients progressed from steatosis to steatohepatitis with fibrosis.
NASH has a variable histological course. However, one third of patients have fibrosis progression, and one third of these have rapid progression to advanced fibrosis. Histological progression correlated with higher serum AST but no other clinical factors. Steatosis alone may progress to NASH with fibrosis.
Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that can progress to cirrhosis and hepatocellular carcinoma. NAFLD has been associated with obesity and other features of the metabolic syndrome, including insulin resistance, impaired glucose tolerance, and dyslipidemia. As a result, and with a lack of other effective treatments, weight loss achieved through lifestyle modifications (diet and exercise) has been promoted as the standard treatment. However, there is very little empiric evidence to support the effectiveness of weight loss for NAFLD. This article reviews the current literature on the effects of weight loss achieved through lifestyle modification or medications on NAFLD. To date, there have been no randomized controlled trials of weight loss interventions on hepatic pathology. Only three published trials (N = 89 subjects), which include a comparison group, have been published. These studies suggest improvement in liver enzymes and/or hepatic pathology; however, direct between group comparisons are lacking. Four small, nonrandomized studies (N = 59 subjects) have evaluated the effect of weight loss achieved with medications (4 of orlistat, 1 of sibutramine) on NAFLD. These suggest some improvement in liver enzymes and histopathology. Finally, a brief review of observational studies on the association between NAFLD pathology or liver enzymes and diet composition suggests a possible role for the manipulation of macronutrients and/or micronutrients in NAFLD treatment. In summary, there is little empiric evidence to support the role of weight loss achieved through lifestyle modification or medication in the treatment of NAFLD. Rigorously conducted, randomized controlled trials are needed in this area.
This document presents the official position of the American Association for the Study of Liver Diseases (AASLD) on the application of serum alanine aminotransferase (ALT) activity, based upon an analysis of the currently available scientific data. Its authorship was selected by the Public Policy Committee. The document is fully endorsed by the AASLD Governing Board.
The natural history of nonalcoholic fatty liver disease: A clinical histopathological study
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A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C