Ayati Ariyan, Vahed Iman Elahi, Rahimi Yasaman, Karbasi Shima, Safdari Ali, Razaghi Mahkameh, Bazrgar Aida, Bafrani Melika Arab, Mousavi Nasab Mohammad Mehdi, Noroozi Masoud, Noori Shokoofeh, Rahmanian Mohammad
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Hepatol Forum. 2025 May 22;6(3):129-136. doi: 10.14744/hf.2024.2024.0047. eCollection 2025.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a persistent hepatic condition linked with cardiovascular disorders and metabolic disturbances. Characterized by inflammation, fat accumulation, and fibrosis within the liver, MASLD can develop into liver cancer and cirrhosis. With a global prevalence of 32.4%, the condition parallels rising obesity rates. Orlistat inhibits lipase enzymes and, therefore, reduces dietary fat absorption, which may benefit MASLD patients. The present systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Searches of PubMed, Scopus, Web of Science, and Embase up to January 2025 were performed using specific keywords and MeSH terms. Bias assessment and data extraction were conducted using Joanna Briggs Institute (JBI) tools independently by two researchers. Statistical analyses were performed with Stata version 14, calculating standardized mean differences, 95% confidence intervals (CI), and heterogeneity (by performing Cochran's Q test and I index). Moreover, meta-regression, subgroup analyses, and sensitivity analyses were conducted. Eleven studies featuring 582 participants were included. Orlistat treatment induced a significant reduction in levels of alanine transaminase (ALT) (SMD = -26.23; 95% CI = -34.70 to -17.76) and aspartate aminotransferase (AST) (SMD = -19.62; 95% CI = -28.33 to -10.92). Furthermore, reductions in HOMA-IR, body mass index, cholesterol, insulin, and waist circumference were observed. The included studies exhibited low to moderate heterogeneity for most outcomes, indicating consistent results across trials. Orlistat significantly improved AST, ALT, and some other metabolic parameters in MASLD patients, suggesting its potential as an additional treatment option. However, the outcome must be interpreted cautiously, considering study heterogeneity. Further high-quality, multicenter research is necessary to confirm these results.
代谢功能障碍相关脂肪性肝病（MASLD）是一种与心血管疾病和代谢紊乱相关的持续性肝脏疾病。MASLD的特征是肝脏内出现炎症、脂肪堆积和纤维化，可发展为肝癌和肝硬化。该疾病在全球的患病率为32.4%，与肥胖率的上升趋势一致。奥利司他可抑制脂肪酶，从而减少膳食脂肪吸收，这可能对MASLD患者有益。本系统评价和荟萃分析是按照PRISMA指南进行的。截至2025年1月，使用特定关键词和医学主题词（MeSH）在PubMed、Scopus、科学网和Embase中进行了检索。由两名研究人员独立使用乔安娜·布里格斯研究所（JBI）工具进行偏倚评估和数据提取。使用Stata 14版进行统计分析，计算标准化均值差、95%置信区间（CI）和异质性（通过进行 Cochr an Q检验和I指数）。此外，还进行了meta回归、亚组分析和敏感性分析。纳入了11项研究，共582名参与者。奥利司他治疗可显著降低丙氨酸转氨酶（ALT）水平（标准化均值差= -26.23；95%CI = -34.70至-17.76）和天冬氨酸转氨酶（AST）水平（标准化均值差= -19.62；95%CI = -28.33至-10.92）。此外，还观察到稳态模型评估的胰岛素抵抗（HOMA-IR）、体重指数、胆固醇、胰岛素和腰围有所降低。纳入的研究在大多数结局方面表现出低至中度异质性，表明各试验结果一致。奥利司他可显著改善MASLD患者的AST、ALT和其他一些代谢参数，表明其作为一种额外治疗选择的潜力。然而，考虑到研究的异质性，对结果的解读必须谨慎。需要进一步开展高质量、多中心研究来证实这些结果。
