Data_Sheet_1_Functional foods and dietary supplements in the management of non-alcoholic fatty liver disease: A systematic review and meta-analysis.doc

ObjectiveIn this systematic review and meta-analysis, we aimed to clarify the overall effects of functional foods and dietary supplements in non-alcoholic fatty liver disease (NAFLD) patients.MethodsRandomized controlled trials (RCTs) published in PubMed, ISI Web of Science, Cochrane library, and Embase from January 1, 2000 to January 31, 2022 were systematically searched to assess the effects of functional foods and dietary supplements in patients with NAFLD. The primary outcomes were liver-related measures, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatic fibrosis and steatosis, while the secondary outcomes included body mass index (BMI), waist circumference (WC), triacylglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). These indexes were all continuous variables, so the mean difference (MD) was used for calculating the effect size. Random-effects or fixed-effects models were used to estimate the mean difference (MD). The risk of bias in all studies was assessed with guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions.ResultsTwenty-nine articles investigating functional foods and dietary supplements [antioxidants (phytonutrients and coenzyme Q10) = 18, probiotics/symbiotic/prebiotic = 6, fatty acids = 3, vitamin D = 1, and whole grain = 1] met the eligibility criteria. Our results showed that antioxidants could significantly reduce WC (MD: −1.28 cm; 95% CI: −1.58, −0.99, P < 0.05), ALT (MD: −7.65 IU/L; 95% CI: −11.14, −4.16, P < 0.001), AST (MD: −4.26 IU/L; 95% CI: −5.76, −2.76, P < 0.001), and LDL-C (MD: −0.24 mg/dL; 95% CI: −0.46, −0.02, P < 0.05) increased in patients with NAFLD but had no effect on BMI, TG, and TC. Probiotic/symbiotic/prebiotic supplementation could decrease BMI (MD: −0.57 kg/m2; 95% CI: −0.72, −0.42, P < 0.05), ALT (MD: −3.96 IU/L; 95% CI: −5.24, −2.69, P < 0.001), and AST (MD: −2.76; 95% CI: −3.97, −1.56, P < 0.0001) levels but did not have beneficial effects on serum lipid levels compared to the control group. Moreover, the efficacy of fatty acids for treating NAFLD was full of discrepancies. Additionally, vitamin D had no significant effect on BMI, liver transaminase, and serum lipids, while whole grain could reduce ALT and AST but did not affect serum lipid levels.ConclusionThe current study suggests that antioxidant and probiotic/symbiotic/prebiotic supplements may be a promising regimen for NAFLD patients. However, the usage of fatty acids, vitamin D, and whole grain in clinical treatment is uncertain. Further exploration of the efficacy ranks of functional foods and dietary supplements is needed to provide a reliable basis for clinical application.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier: CRD42022351763.

本研究旨在通过对功能性食品和膳食补充剂在非酒精性脂肪性肝病（NAFLD）患者中整体效应的系统评价与荟萃分析，以阐明其作用。研究方法包括对PubMed、ISI Web of Science、Cochrane图书馆和Embase数据库中自2000年1月1日至2022年1月31日发表的随机对照试验（RCTs）进行系统检索，以评估功能性食品和膳食补充剂在NAFLD患者中的影响。主要结局指标为与肝脏相关的指标，如丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）以及肝纤维化和脂肪变性，而次要结局指标包括体重指数（BMI）、腰围（WC）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）。这些指标均为连续变量，因此使用均数差（MD）来计算效应量。通过使用随机效应模型或固定效应模型来估计均数差。所有研究的偏倚风险均根据Cochrane手册中提供的指南进行评估。结果显示，抗氧化剂可以显著降低NAFLD患者的腰围（MD：-1.28厘米；95% CI：-1.58至-0.99，P < 0.05）、ALT（MD：-7.65 IU/L；95% CI：-11.14至-4.16，P < 0.001）、AST（MD：-4.26 IU/L；95% CI：-5.76至-2.76，P < 0.001）和LDL-C（MD：-0.24 mg/dL；95% CI：-0.46至-0.02，P < 0.05），但对BMI、TG和TC无影响。益生菌/共生体/益生元补充剂可以降低BMI（MD：-0.57 kg/m2；95% CI：-0.72至-0.42，P < 0.05）、ALT（MD：-3.96 IU/L；95% CI：-5.24至-2.69，P < 0.001）和AST（MD：-2.76；95% CI：-3.97至-1.56，P < 0.0001）水平，但与对照组相比，对血清脂质水平没有产生有益影响。此外，脂肪酸治疗NAFLD的有效性存在分歧。此外，维生素D对BMI、肝转氨酶和血清脂质没有显著影响，而全谷物可以降低ALT和AST，但不会影响血清脂质水平。结论：本研究表明，抗氧化剂和益生菌/共生体/益生元补充剂可能成为NAFLD患者的有前景治疗方案。然而，脂肪酸、维生素D和全谷物在临床治疗中的应用尚不明确。为进一步探究功能性食品和膳食补充剂的疗效等级，以提供临床应用的可靠依据，尚需进一步研究。系统评价注册：https://www.crd.york.ac.uk/prospero，标识符：CRD42022351763。