Efficacy of different interventions for nonalcoholic fatty liver disease: A meta-analysis of lifestyle modifications, silymarin, and medications

source extracted confidence: high 2026-04-09
#humans #diet-mediterranean #life-style #non-alcoholic-fatty-liver-disease #silymarin

Efficacy of different interventions for nonalcoholic fatty liver disease: A meta-analysis of lifestyle modifications, silymarin, and medications

Zhang et al., 2025 | Asia Pac J Clin Nutr | Meta Analysis

Citation

Zhang Zhen, Li Shuai, Sun Jianjun. Efficacy of different interventions for nonalcoholic fatty liver disease: A meta-analysis of lifestyle modifications, silymarin, and medications. Asia Pac J Clin Nutr. 2025-Aug;34(4):516-530. doi:10.6133/apjcn.202508_34(4).0003

Abstract

BACKGROUND AND OBJECTIVES: To compare the effectiveness of silymarin or its combination with lifestyle modifications, Mediterranean hypocaloric diets, and medications for improving nonalcoholic fatty liver disease (NAFLD). METHODS AND STUDY DESIGN: PubMed, Embase, Cochrane Library, Web of Science, and Clin-icalTrails.gov were used to identify relevant studies. The treatment arm was silymarin or its combination with Mediterranean hypocaloric diets, medications, or lifestyle modifications. The comparators were placebo, Mediterranean hypocaloric diets, medications, and lifestyle modifications. RESULTS: This meta-analysis included 25 studies with 2283 patients. Total cholesterol levels were reduced by silymarin+Mediterranean hypocaloric diets (SMD: -0.39 (-0.81, 0.03), p=0.072) or medications [SMD: -1.12 (-1.67, -0.58), p<0.001]. Triglyceride levels were decreased by silymarin combined with the medication [SMD: -0.92 (-1.98, 0.14), p=0.080]. Low-density lipoprotein cholesterol levels were reduced by silymarin alone [SMD: -0.25 (-0.48, -0.03), p=0.027]. The combination of silymarin with Mediterranean hypocaloric diets [SMD: -0.47 (-0.90, -0.04), p=0.031] or lifestyle modifications [SMD: -0.88 (-1.09, -0.66), p<0.0001] decreased alanine aminotransferase levels. Aspartate aminotransferase levels were reduced by a combination of silymarin and life-style modifications [SMD: -0.72 (-1.49, 0.05), p=0.061] or medications [SMD: -1.41 (-2.24, -0.59), p=0.005]. Silymarin (2.5 times) or silymarin plus lifestyle modifications (39%) reduced the hepatic steatosis rate in patients with NAFLD. The silymarin use increased the rate of patients with adverse effects [RR:1.98 (1.11, 3.54)]; gastrointestinal problems were the most common adverse effects. CONCLUSIONS: Despite the overall advantages of therapies, different interventions showed different effects on markers in patients with NAFLD. These results highlight the need for more research to fully comprehend the features of the intervention.

Key Findings

This meta-analysis included 25 studies with 2283 patients. Total cholesterol levels were reduced by silymarin+Mediterranean hypocaloric diets (SMD: -0.39 (-0.81, 0.03), p=0.072) or medications [SMD: -1.12 (-1.67, -0.58), p<0.001]. Triglyceride levels were decreased by silymarin combined with the medication [SMD: -0.92 (-1.98, 0.14), p=0.080]. Low-density lipoprotein cholesterol levels were reduced by silymarin alone [SMD: -0.25 (-0.48, -0.03), p=0.027]. The combination of silymarin with Mediterr

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population nafld
Sample Size 2283
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Diet, Mediterranean
  • Life Style
  • Non-alcoholic Fatty Liver Disease
  • Silymarin
  • Treatment Outcome

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis
  • Vertical: milk-thistle

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09