Non-Alcoholic Fatty Liver Disease treated by Omega-3 – three meta-analysis 2016-2017

Omega-3 treats NAFLD - meta-analysis Oct 2016

Effectiveness of Omega-3 Polyunsaturated Fatty Acids in Non-Alcoholic Fatty Liver Disease:
A Meta-Analysis of Randomized Controlled Trials - Oct 2016
Xi-Xi He, Xiao-Li Wu, Ren-Pin Chen, Chao Chen, Xiao-Gang Liu, Bin-Jiao Wu, Zhi-Ming Huang
PLOS ONE, Published: October 6, 2016http://dx.doi.org/10.1371/journal.pone.0162368

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Background: Non-alcoholic fatty liver disease (NAFLD) is a clinical syndrome with the main characteristic of diffuse liver cells with fatty changes. The clinical evolution of NAFLD includes simple non-alcoholic fatty liver, non-alcoholic steatohepatitis (NASH), liver fibrosis and cirrhosis, and even hepatocellular carcinoma.

Methods and Findings: We conducted this review to identify the effectiveness of omega-3 polyunsaturated fatty acids (ω-3 PUFA) in NAFLD. We searched PubMed, Cochrane Library and Embase. All randomized controlled trials (RCTs) of ω-3 PUFA treatment for NAFLD were considered. Two reviewers assessed the quality of each study and collected data independently. Disagreements were resolved by discussion among the reviewers and any of the other authors of the paper. We performed a meta-analysis and reported summary estimates of outcomes as inverse variance (IV), fixed or random, with 95% confidence intervals (CIs). We included seven RCTs involving 442 patients (227 for the experimental group and 215 for the control group). All the patients were divided into two groups: one treated with ω-3 PUFA and the other was the control group (generally placebo). The demographics of the ω-3 PUFA and control groups were comparable.

Beneficial changes in

• alanine aminotransferase (ALT) (IV 95% CI: 7.61 [ 12.83 to 2.39], p = 0.004),
• total cholesterol (TC) (IV 95% CI: 13.41 [ 21.44 to 5.38], p = 0.001),
• triglyceride (TG) (IV 95% CI: 43.96 [ 51.21 to 36.71], p<0.00001) and
• high-density lipoprotein cholesterol (HDL-C) (IV 95% CI: 6.97 [2.05 to 11.90], p = 0.006)

favored ω-3 PUFA treatment.
Omega-3 PUFA tended towards a beneficial effect on aspartate aminotransferase (AST) (IV 95% CI: 6.89 [ 17.71 to 3.92], p = 0.21), γ-glutamyl transferase (GGT) (IV 95% CI: 8.28 [ 18.38 to 1.83], p = 0.11) and low-density lipoprotein cholesterol (LDL-C) (IV 95% CI: 7.13 [ 14.26 to 0.0], p = 0.05).

Conclusions: Supplementation with ω-3 PUFA is a practical and effective treatment for NAFLD to decrease ALT, TC and increase HDL-C, especially to decrease TG. Omega-3 PUFA also has a tendency toward a beneficial effect on AST, GGT and LDL-C. More high-quality, large RCTs are needed to validate our findings.

Omega-3 treats NAFLD in children – meta-analysis Dec 2016

Omega-3 fatty acids as a treatment for non-alcoholic fatty liver disease in children:
A systematic review and meta-analysis of randomized controlled trials
Clinical Nutrition, online 23 December 2016
Results: In total, 4 studies with 263 subjects were identified. PUFA supplementation was associated with significantly improved hepatic steatosis grade on ultrasound (risk difference: 25%, 95% CI: 12–38%), without heterogeneity (P = 0.27, I2 = 24%).
Sensitivity analysis confirmed the robustness of our findings.
PUFA supplementation could decrease AST levels after 6 months, but could only reduce ALT levels after 12 months.
PUFA did not have a significant effect on most components of metabolic syndrome and the CRP level.
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Omega-3 treats NAFLD – meta-analysis Aug 2017

The effect of omega-3 unsaturated fatty acids on non-alcoholic fatty liver disease:
A systematic review and meta-analysis of RCTs
Le Yu1, Man Yuan2, Linchun Wans3

Objective: During the treatment of diseases such as angiocardiopathy, blood lipid abnormalities and metabolic syndrome, omega-3 unsaturated fatty acids (PUFA) can reduce plasma lipids and improve cardiovascular status, thus ameliorating disease severity. We aimed to explore the effects of PUFA supplementation in patients with non-alcoholic fatty liver disease (NAFLD).

Methods: A systematic literature search was performed during March 2016 for randomized controlled trials using PUFA or fish oil supplementation in patients with NAFLD or non-alcoholic steatohepatitis (NASH). All Randomized controlled trials were retrieved from MEDLINE and EMBASE database up to date (March 2016). A meta-analysis of key outcomes (serum level of liver enzymes and lipids) were identified in these studies. The mean difference (MD) and the corresponding 95% confidence intervals (CIs) were used as measures of effect size.

Results: Thirteen studies were included, consisting of 266 patients in the PUFA group and 402 cases in the control group. Serum level of alanine aminotransferase (ALT) was lower in the PUFA group than that in in the controls [MD=-9.18, 95% CI (-12.41, -5.96), P <0.00001]. However, PUFA treatment did not affect aspartate aminotransferase (AST) [MD=-5.07, 95% CI (-12.65, 2.51), P= 0.19], gamma-glutamyl transferase (GGT) [MD=-1.91, 95% CI (-4.15, 0.33), P <0.009].

Conclusions: PUFA supplementation may affect serum level of ALT and improve liver function in patients with NAFLD.

NAFLD ALT

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