Table 3.

The efficiency of citrulline, yogurts, soy milk, propolis, omega-3 fatty acids, and vitamin supplementation in NAFLD patients.

Study	Group *	Diagnosis	Substance	Duration	Results **	Possible Mechanism
Darabi et al. [171] (2019)	44 patients with NAFLD (22 in citrulline group)	Fibroscan	Citrulline in dose 500 mg four times a day	12 weeks	↓: TNF-α, hs-CRP, NF-κB, ALT, liver steatosis	Reduction in TLR4 gene expression may lead to decrease in NF-kB activation and TNF-α production; decrease in oxidative stress by increase in SOD may lead to reduction in ERK1/2 signaling activation, and what follows this is a decrease in NF-kB activity and TNF-α production; protection against hepatic lipid peroxidation
Bakhshimoghaddam et al. [174] (2018)	102 patients with NAFLD (34 in symbiotic yogurt group)	USG	300 g of symbiotic yogurt (containing 108 colony-forming units Bifidobacterium animalis/mL and 1.5 g inulin) per day	24 weeks	↓: NAFLD grade (USG), ALT, AST, ALP, GGT	Modulation of intestinal microbiota, and improvements in gut barrier; improvements in insulin resistance; improvements in post-prandial absorption of micro- and macronutrients, including antioxidants; increased production of GLP-2
Maleki et al. [177] (2019)	62 patients with NAFLD (31 in soy milk group)	USG	Soy milk in dose 240 mL per day + 500 calorie-deficit diet	8 weeks	↑: QUICKI ↓: Serum insulin, SBP, DBP, HOMA-IR	Decrease in intestinal alpha-glucosidase and protein tyrosine kinase activity; increased glucose uptake by glucose transporter type 4; inhibition of lipogenesis by decrease in ChREBP, SREBP1, LXR, and RXR expression
Soleimani et al. [182] (2021)	54 patients with NAFLD (27 in propolis group)	Elastography	Propolis tablets (250 mg twice a day)	4 months	↓: Liver stiffness, hs-CRP	Impact on cholesterol metabolism by upregulation of Apo A1 and ATP-binding cassette transporters A1 and G1 gene expression; inhibition of HMG-COA reductase gene expression; anti-inflammatory properties due to Nrf-2 activation, inhibition of IκBα, JNK, ERK1/2, and p38MAPK phosphorylation
Qin et al. [193] (2015)	70 patients with NAFLD (36 patients in fish oil group)	USG	Fish oil in 1g capsules, two capsules twice per day	3 months	↑: Adiponectin ↓: TG, TC, apolipoprotein B, glucose, ALT, GGT, TNF- α, FGF21, leukotrienes B, cytokeratin 18 fragment M30, prostaglandin E2	Anti-inflammatory effects, decrease in NF-kB activity; inhibition of prostaglandin E2 leads to improvements in lipid profile
Rahimpour et al. [201] (2022)	22 overweight women with NAFLD (11 in vitamin D group)	USG	Vitamin D in dose 2000 IU per day + eccentric exhaustive exercise training at the beginning and at the endpoint	6 weeks	↓: BW, BMI, WHR, body fat percentage	Increase in lipoprotein lipase activity; inhibition of serum parathyroid hormone; improvement in calcium homeostasis as calcium affects bile acids to excrete fatty acids; improvement in IR; inhibition of lipogenesis and improvement in fatty acid oxidation
Pervez et al. [205] (2020)	71 patients with NAFLD (35 in δ-tocotrienol group)	USG	δ-tocotrienol in dose 300 mg twice a day	24 weeks	↓: FLI, HOMA-IR, hs-CRP, MDA, ALT, AST, hepatic steatosis	Upregulation of PPAR α and δ, and downregulation of fatty acid biosynthesis enzymes, e.g., HMGC, which leads to inhibition of adipogenesis; decrease in leptin level; increase in adiponectin

Abbreviations: ALP—alkaline phosphatase, ALT—alanine aminotransferase, AST—aspartate aminotransferase, ATP—Adenosine triphosphate, BMI—body mass index, BW—bodyweight, ChREBP—carbohydrate responsive element binding protein, DBP—diastolic blood pressure, ERK 1/2—extracellular signal-regulated protein kinases 1 and 2, FGF21—fibroblast growth factor 21, FLI—fatty liver index, GGT—γ-glutamyltranspeptidase, GLP—glucagon-like peptide, HMGCR—3-hydroxy-3-methylglutaryl-CoA reductase, HOMA-IR—homeostasis model assessment of insulin resistance, hs-CRP—high sensitive C-reactive protein, IκBα—nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor alpha, JNK—c-Jun N-terminal kinase, LXR—liver X receptor, MDA—malondialdehyde, NAFLD—non-alcoholic fatty liver disease, NF-κB—nuclear factor kappa B, Nrf2—nuclear factor erythroid 2-related factor 2, QUICKI—quantitative insulin sensitivity check index, p38MAPK—p38 mitogen-activated protein kinase, PPAR—peroxisome proliferator-activated receptor, RXR—retinoid-X-receptor, SBP—systolic blood pressure, SOD—superoxide dismutase, SREBP1—sterol-regulatory element binding protein-1, TC—total cholesterol, TG—triglycerides, TGF-β—transforming growth factor-beta, TLR4—Toll-like receptor 4, TNF- α—tumor necrosis factor alpha, USG—ultrasonography, WHR—waist to hip ratio. * In the group column, the number of respondents analyzed was 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.