TOPLINE: 

In patients with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) but not diabetes, berberine was safe but did not reduce visceral adipose tissue or liver fat. 

METHODOLOGY:

• Researchers enrolled 337 individuals without diabetes but with obesity and MASLD (mean age, 42 years; 66% men) at 11 hospitals in China.
• Participants were randomly assigned to receive either oral berberine 1 g/d or placebo and followed for 6 months.

TAKEAWAY: 

• Mean medication adherence rates were similar between the groups: 90.3% for berberine and 90.7% for placebo.
• No significant differences were observed between the groups for visceral adipose tissue area (1.4%) or liver fat content (0.9%).
• Berberine was associated with larger reductions vs placebo in low-density lipoprotein cholesterol (LDL-C; -7.72 mg/dL), apolipoprotein B (apoB; -3.42 mg/dL), and high-sensitivity C-reactive protein (hs-CRP; -0.072 mg/dL).
• The incidence of adverse events was similar between the groups.

IN PRACTICE:

“Despite its neutral effect on adiposity in our study, berberine produced modest reductions in key atherogenic lipids (LDL-C, apoB) and systemic inflammation (hs-CRP). These findings are promising for the prevention of cardiovascular diseases and extend prior evidence of the cardiometabolic benefits of berberine to diabetes-free individuals with obesity and MASLD, an understudied population with a metabolic high risk,” the authors wrote.

SOURCE:

The study was led by Lubi Lei of Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing. It was published online on January 16, 2026, in JAMA Network Open.

LIMITATIONS: 

Study limitations included a small proportion (4.4%) of missing measurements for liver fat content due to uninterpretable images. Also, the results of the secondary and exploratory analyses on LDL-C, apoB, and hs-CRP, as well as subgroup analysis of hs-CRP, were presented without adjustment for multiplicity and should not be used to infer definitive treatment effects

DISCLOSURES:

This work was supported by the China Academy of Chinese Medical Sciences Innovation Fund for Medical Science and received free study drugs from Yunnan Biovalley Pharmaceutical Co Ltd. No conflicts of interest were reported.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.