Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha, China.
School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, China.
Front Immunol. 2022 Sep 9;13:949746. doi: 10.3389/fimmu.2022.949746. eCollection 2022.
Dietary polyphenol treatment of non-alcoholic fatty liver disease (NAFLD) is a novel direction, and the existing clinical studies have little effective evidence for its therapeutic effect, and some studies have inconsistent results. The effectiveness of dietary polyphenols in the treatment of NAFLD is still controversial. The aim of this study was to evaluate the therapeutic efficacy of oral dietary polyphenols in patients with NAFLD.
The literature (both Chinese and English) published before 30 April 2022 in PubMed, Cochrane, Medline, CNKI, and other databases on the treatment of NAFLD with dietary polyphenols was searched. Manual screening, quality assessment, and data extraction of search results were conducted strictly according to the inclusion and exclusion criteria. RevMan 5.3 software was used to perform the meta-analysis.
The RCTs included in this study involved dietary supplementation with eight polyphenols (curcumin, resveratrol, naringenin, anthocyanin, hesperidin, catechin, silymarin, and genistein) and 2,173 participants. This systematic review and meta-analysis found that 1) curcumin may decrease body mass index (BMI), Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Triglycerides (TG) total cholesterol (TC), and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) compared to placebo; and curcumin does not increase the occurrence of adverse events. 2) Although the meta-analysis results of all randomized controlled trials (RCTs) did not reveal significant positive changes, individual RCTs showed meaningful results. 3) Naringenin significantly decreased the percentage of NAFLD grade, TG, TC, and low-density lipoprotein cholesterol (LDL-C) and increased high-density lipoprotein cholesterol (HDL-C) but had no significant effect on AST and ALT, and it is a safe supplementation. 4) Only one team presents a protocol about anthocyanin (from L. fruit extract) in the treatment of NAFLD. 5) Hesperidin may decrease BMI, AST, ALT, TG, TC, HOMA-IR, and so on. 6) Catechin may decrease BMI, HOMA-IR, and TG level, and it was well tolerated by the patients. 7) Silymarin was effective in improving ALT and AST and reducing hepatic fat accumulation and liver stiffness in NAFLD patients.
Based on current evidence, curcumin can reduce BMI, TG, TC, liver enzymes, and insulin resistance; catechin can reduce BMI, insulin resistance, and TG effectively; silymarin can reduce liver enzymes. For resveratrol, naringenin, anthocyanin, hesperidin, and catechin, more RCTs are needed to further evaluate their efficacy and safety.
饮食多酚治疗非酒精性脂肪性肝病（NAFLD）是一个新的方向，现有临床研究对其疗效的证据很少，一些研究结果不一致。饮食多酚治疗 NAFLD 的疗效仍存在争议。本研究旨在评估口服饮食多酚治疗 NAFLD 的疗效。
检索了 2022 年 4 月 30 日前在 PubMed、Cochrane、Medline、CNKI 等数据库中发表的关于饮食多酚治疗 NAFLD 的中英文文献。根据纳入和排除标准，严格进行文献筛选、质量评估和数据提取。采用 RevMan 5.3 软件进行荟萃分析。
本研究纳入的 RCT 涉及 8 种多酚（姜黄素、白藜芦醇、柚皮苷、花青素、橙皮苷、儿茶素、水飞蓟素和染料木黄酮）和 2173 名参与者的饮食补充。本系统评价和荟萃分析发现：1）与安慰剂相比，姜黄素可能降低体重指数（BMI）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、甘油三酯（TG）、总胆固醇（TC）和胰岛素抵抗评估-稳态模型（HOMA-IR）；姜黄素不会增加不良事件的发生。2）虽然所有随机对照试验（RCT）的荟萃分析结果并未显示出显著的积极变化，但个别 RCT 显示出有意义的结果。3）柚皮苷可显著降低 NAFLD 分级、TG、TC 和低密度脂蛋白胆固醇（LDL-C），增加高密度脂蛋白胆固醇（HDL-C），但对 AST 和 ALT 无显著影响，且安全性较高。4）仅有一组研究人员提出了一项关于（从 L. 果实提取物中提取的）花青素治疗 NAFLD 的方案。5）橙皮苷可能降低 BMI、AST、ALT、TG、TC、HOMA-IR 等。6）儿茶素可降低 BMI、HOMA-IR 和 TG 水平，且患者耐受性良好。7）水飞蓟素可改善 NAFLD 患者的 ALT 和 AST，并减少肝脂肪堆积和肝硬度。
基于现有证据，姜黄素可降低 BMI、TG、TC、肝酶和胰岛素抵抗；儿茶素可有效降低 BMI、胰岛素抵抗和 TG；水飞蓟素可降低肝酶。对于白藜芦醇、柚皮苷、花青素、橙皮苷和儿茶素，需要更多的 RCT 来进一步评估其疗效和安全性。
