Table 2.
The efficiency of fruit, vegetable, flower, and spice supplementation in NAFLD patients.
| Study | Group * | Diagnosis | Substance | Duration | Results ** | Possible Mechanism |
|---|---|---|---|---|---|---|
| Hormoznejad et al. [121] (2020) | 41 patients with NAFLD (20 in cranberry group) | USG | Vaccinium macrocarpon extract in tablets (144 mg) twice a day + weight-loss diet | 12 weeks | ↓: ALT, insulin, HOMA-IR | Decrease in hepatic inflammation, as evidenced by decreased TNF- α, NF-κB, COX2, and IκB mRNA expression; inhibition of release of TNF- α, IL-1β, IL-6, and IL-8 from lipopolysaccharide |
| Goodarzi et al. [124] (2021) | 44 patients with NAFLD (22 in pomegranate extract group) | USG | Pomegranate extract in dose 225 mg twice a day | 12 weeks | ↑: HDL-C ↓: TC, TG, LDL to HDL ratio, FPG, HOMA-IR, DBP, BMI, BW, WC |
Anti-obesity effect gained by decrease in pancreatic lipase activity and energy intake, reduction in fat absorption and elevation of its fecal secretion; agonist action on PPAR-α and PPAR-γ; decrease in resistin secretion |
| Namkhah et al. [127] (2021) | 44 patients with NAFLD (22 in naringenin group) | USG | Naringenin in dose 100 mg twice a day | 4 weeks | ↑: HDL-C ↓: BW, BMI, TG, TC, LDL-C, NAFLD grade |
Inhibition of overproduction of VLD; modification of expression of genes related to lipid metabolism: upregulation the expression of PPAR-α and PPAR-γ genes, modulation of CPT1α, SREBF1c genes, and HMG-CoA reductase; alterations in collagen deposition, modulation of oxidative stress and inflammatory process |
| Ferro et al. [132] (2020) | 86 patients with liver steatosis (45 in intervention group) | Transient elastography | Bergamot polyphenol fraction and Cynara Cardunculus extract in dose 300 mg per day | 12 weeks | ↓: BW, BMI CAP score decreased only in subjects over 50 years |
Regulating the potential of the mitochondrial membrane and oxidative phosphorylation; upregulation of antioxidant-related genes; anti-inflammatory properties |
| Sangouni et al. [138] (2020) | 88 patients with NAFLD (45 in garlic group) | USG | 400 mg of garlic powder four times a day | 12 weeks | ↑: HDL-C ↓: Liver steatosis, ALT, GGT, TC, TG, LDL |
Lipogenesis modulation by lowering the activity of enzymes involved in hepatic fat synthesis; decrease in insulin resistance, activity of NF-κB pathway, and oxidative stress |
| Damavandi et al. [143] (2021) | 71 patients with NAFLD (37 in purslane group) | USG | Purslane extract, 300 mg once a day | 12 weeks | ↓: ALT, AST, GGT, FPG, TG, LDL-C | Improvements in glucose uptake and fatty acid metabolism; increase in insulin secretion from β-cells; activation of AMPK and PI3K pathways in skeletal muscles; upregulation of GLUT-4 gene expression; enhancing GLP-1 concentration; inhibition of pancreatic lipase activity, decrease in ACC activity |
| Panahi et al. [147] (2018) | 81 patients with NAFLD (41 in artichoke group) | USG | Artichoke leaf extracts in dose 600 mg per day | 2 months | ↑: Hepatic vein flow, AST/ALT ratio ↓: Portal vein diameter, liver size, ALT, AST, total bilirubin, LDL-C, TC, TG, HDL-C, non-HDL-C, BMI, WC, APRI |
Enhancement of expression of the following genes: malic enzyme 1, decorin, cytochrome P450, family 1, subfamily a, polypeptide 2 and nicotinamide phosphoribosyltransferase, which leads to improvements in fatty acids metabolism, inflammation, and liver fibrosis |
| Izadi et al. [151] (2021) | 61 patients with NAFLD (30 in sour tea group) | USG | Sour tea powder in capsule in dose 450 mg | 8 weeks | ↓: TG, ALT, AST, SBP, DBP, TAC | Mechanisms are not fully understood; probably improvements are due to an inhibition of fatty acid synthesis, decrease in lipogenesis, improvements in mitochondrial activity and β-oxidation, decrease in production of reactive oxygen species, proinflammatory cytokines and chemokines in liver |
| Jeong et al. [155] (2017) | 60 patients with NAFLD (20 in 400 mg dose of HL) | USG | Magnolia officinalis extract–HL tablet in dose 400 mg per day | 12 weeks | ↓: HFC | Anti-inflammatory and antioxidant properties; induction of apoptosis of the activated hepatic stellate cells; inhibition of liver toxicity and lipid accumulation |
| Askari et al. [158] (2014) | 45 patients with NAFLD (23 in intervention group) | USG | Cinnamon in dose 750 mg twice a day | 12 weeks | ↓: HOMA-IR, FPG, TC, TG, ALT, AST, GGT, hs-CRP | Reduction in post-prandial glucose absorption gained due to inhibition of pancreatic α-amylase and α-glucosidase; stimulation of glucose metabolism and glucose uptake by improving glucose transporter-4; decrease in gluconeogenesis and improvement in IR |
| Daneshi-Maskooni et al. (2019) [162] | 87 patients with NAFLD (43 in cardamom group) | USG | Cardamom in dose 1 g three times per day with meals | 3 months | ↑: Irisin, HDL, QUICKI ↓: fasting insulin, TG, HOMA-IR, fatty liver grade |
Increase in antioxidant capability, PPAR-γ expression; decrease in inflammation and cholesterol synthesis; improvement in IR |
| Rahmani et al. [165] (2016) | 77 patients with NAFLD (37 in curcumin group) | USG | Amorphous dispersion curcumin formulation in dose 500 mg per day (equal to 70 mg of curcumin) | 8 weeks | ↓: HFC, BMI, TC, LDL-C, TG, ALT, AST, FPG, HbA1c | Inhibition of oxidative stress and NF-κB; downregulation of pro-inflammatory cytokines, COX-2, collagen 1, inducible nitric oxide synthase, and ICAM-1; improvements in acyl-CoA oxidase activity and lipid peroxidation through glutathione level modulation |
Abbreviations: ACC—acetyl-coA carboxylase, ALT—alanine aminotransferase, AMPK—5′-adenosine monophosphate-activated protein kinase, APRI—aspartate aminotransferase to platelet ratio index, AST—aspartate aminotransferase, BMI—body mass index, BW—bodyweight, CAP—controlled attenuation parameter, COX2—cyclooxygenase-2, CPT1α—carnitine palmitoyltransferase 1α, DBP—diastolic blood pressure, FPG—fasting plasma glucose, GGT—γ-glutamyltranspeptidase, GLP-1—glucagon-like peptide-1, GLUT-4—glucose transporter-4, HbA1c—glycated hemoglobin, HDL-C—high density lipoprotein cholesterol, HFC—hepatic fat content, HMG-CoA—3-hydroxy-3-methylglutaryl-Coenzyme A, HOMA-IR—homeostasis model assessment of insulin resistance, hs-CRP—high sensitive C-reactive protein, ICAM-1—intracellular adhesion molecule-1, IL—interleukin, LDL-C—low density lipoprotein cholesterol, NAFLD—non-alcoholic fatty liver disease, NF-κB—nuclear factor kappa-light-chain-enhancer of activated B cells, PI3K—phosphoinositide 3-kinase, PPAR—peroxisome proliferator activated receptor protein, QUICKI—quantitative insulin sensitivity check index, SBP—systolic blood pressure, TAC—total antioxidant capacity, TC—total cholesterol, TG—triglycerides, TNF-α—tumor necrosis factor alpha USG—ultrasonography, VLDL—very low-density lipoprotein, SREBF1c—sterol regulatory element-binding transcription factor-1, WC—waist circumference. * In the group column, the number of respondents analyzed is given, not the people who were included in the study and for various reasons were excluded from it during procedures. ** Changes shown in results column are significant.