Nutritional supplementation in non-alcohol related fatty liver disease: a network meta-analysis.
Komolafe O, Buzzetti E, Linden A, Best LMJ, Madden AM, Roberts D, Chase TJG, Fritche D, Freeman SC, Cooper NJ, Sutton AJ, Milne EJ, Wright K, Pavlov CS,. Davidson BR, Tsochatzis E, Gurusamy KS . Nutritional supplementation in non-alcohol-related fatty liver disease: a network meta-analysis. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013157. doi: 10.1002 /14651858.CD013157.pub2. Accessed July 29, 2021.
Description.
This study was conducted with the aim of evaluating the benefits and harms of different dietary supplements for the treatment of NAFLD through a network meta-analysis and also to generate a ranking of different dietary supplements according to their safety and efficacy.
The main results were that a total of 202 randomized clinical trials (14,200 participants) were included in the review, 19 trials had a low risk of bias, and a total of 32 different interventions were compared in these trials. A total of 115 trials (7732 participants) were included in one or more of the comparisons. The remaining trials did not report any results of interest for this review.
Follow-up ranged from 1 to 28 months, with a follow-up period of 2 to 28 months for trials that reported clinical outcomes. During this follow-up period, clinical events associated with NAFLD, such as mortality, cirrhosis, decompensated liver failure, liver transplantation, hepatocellular carcinoma, and liver-related mortality, were sparse.
Because of the sparsity of data, impact estimates for mortality were not calculated, and no trials reported measuring overall health-related quality of life using validated measures. The evidence appears to be very uncertain about the effect of interventions on serious adverse events (number of people or events).
The very low certainty of the evidence makes it very uncertain about the effect of most of the supplements studied on adverse events, but it is possible that people taking PUFAs (polyunsaturated fatty acids) are more likely to experience adverse events than people who do not receive active interventions.
People taking other supplements (a category that includes vitamins, fatty acids, phospholipids, and nutritional supplements other than antioxidants) also reported a higher number of adverse events than those not receiving active intervention.
The uncertainty in the data is probably due in part to the very short follow-up period, with 8 to 28 years of follow-up needed to detect differences in mortality between NAFLD patients and the general population. Therefore, it is unlikely that differences in clinical outcomes will be found in trials that provide less than 5 to 10 years of follow-up.
The authors conclude that
These lines of evidence indicate considerable uncertainty about the effects of nutritional supplementation compared with no additional intervention on all clinical outcomes in people with non-alcohol-related fatty liver disease.
High quality randomized controlled clinical trials with appropriate follow-up are needed, and registry-based randomized clinical trials or cohort multiple randomized clinical trials comparing interventions such as vitamin E, prebiotics, etc. have been proposed.
The rationale for choosing interventions is the impact of these interventions on indirect outcomes, which may lead to clinical benefits.
