TOPLINE

According to a systematic review and network meta-analysis of trials involving adults with metabolic dysfunction-associated steatotic liver disease (MASLD), certain herbs and herbal products — including artichoke leaf, curcumin (turmeric), green tea, silymarin (milk thistle), flaxseed, and selected garlic-based preparations — were associated with modest, outcome-specific reductions in triglycerides, low-density lipoprotein cholesterol (LDL-C), fasting blood glucose, BMI, and some measures of insulin resistance. None showed a consistent benefit in reducing A1c.

METHODOLOGY

• Given that MASLD is closely linked to dyslipidemia, insulin resistance, and impaired glucose metabolism and that herbal products are widely used despite their unclear comparative metabolic effects, a systematic review and network meta-analysis was conducted to evaluate their effects on metabolic outcomes and the certainty of the evidence for MASLD.
• A total of 123 randomized controlled trials involving 8595 adults with MASLD were included; the trials compared single-compound herbal therapies and derivatives with placebo, no treatment, lifestyle modifications, or standard treatment.
• Studies originated predominantly in Iran (70.2%), with additional contributions from China (12.9%), Italy (8.9%), and other countries; the most frequently studied interventions were silymarin (24 arms), curcumin (13 arms), resveratrol (six arms), green tea (six arms), berberine (five arms), and Nigella sativa (five arms).
• The primary outcomes assessed were changes in triglyceride and fasting blood glucose levels and the homeostatic model assessment of insulin resistance; secondary outcomes were changes in total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and A1c levels, as well as BMI.

TAKEAWAY

• Across 85 studies that assessed triglyceride levels, Korean red ginseng (mean difference, -99.00; P < .01), naringenin (mean difference, -92.50; P < .01), and artichoke leaf (mean difference, -52.60; P < .01) significantly reduced triglyceride levels compared with placebo.
• For fasting blood glucose levels (63 studies), the use of green tea (mean difference, -16.98; P = .03), garlic (mean difference, -13.51; P = .02), and hesperidin plus flaxseed (mean difference, -14.44; P = .01) was associated with the largest reductions.
• For insulin resistance (39 studies), sumac was associated with the most substantial improvement (mean difference, -2.32; P < .01), followed by green tea (mean difference, -1.81; P = .02) and berberine with tocotrienols and green coffee (mean difference, -1.80; P = .02).
• Regarding secondary outcomes, the use of artichoke leaf and curcumin was associated with the largest reductions in total cholesterol and LDL-C levels, green tea and green cardamom modestly raised HDL-C levels, chicory and green tea produced the greatest reductions in BMI, and no herbal intervention significantly reduced A1c levels.

IN PRACTICE

“Rather than demonstrating uniform metabolic improvement across all cardiometabolic features of MASLD, our findings show that herbal interventions exert domain-specific effects on lipid, glycemic, insulin resistance, and anthropometric outcomes,” the authors of the study wrote.

SOURCE

The study was led by Revathi Thirumushi Sairaj of Charing Cross Hospital, Imperial College Healthcare NHS Trust in London, England; Alejandro Chen Liang of Centro de Estudios Universitarios Xochicalco Campus Tijuana in Tijuana, México; and Yeison Cruz Castillo of Universidad Autónoma de Santo Domingo in Santo Domingo, República Dominicana. It was published online in Gastro Hep Advances.

LIMITATIONS

Results varied widely because studies used different herb versions and doses, added other treatments, and followed people for different lengths of time. Most trials were from a single country (mainly Iran), so the findings may not be generalizable. Also, most studies used the older disease names — nonalcoholic fatty liver disease and nonalcoholic steatohepatitis — instead of the newer term MASLD.

DISCLOSURES

No funding was provided by any special agency for this research. All authors disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.