Nutraceutical approaches to non-alcoholic fatty liver disease (NAFLD): A position paper from the International Lipid Expert Panel (ILEP)
Manfredi Rizzo, Alessandro Colletti, Peter E. Penson, Niki Katsiki, Dimitri P. Mikhailidis, Peter P. Tóth, Ioanna Gouni‐Berthold, John Mancini, David Marais, Patrick M. Moriarty, Massimiliano Ruscica, Amirhossein Sahebkar, Dragoş Vinereanu, Arrigo F.G. Cicero, Maciej Banach, Julio Acosta, Mutaz Al-Khnifsawi, Fahad Alnouri, Fahma Amar, Atanas G. Atanasov, Gani Bajraktari, Maciej Banach, Ioanna Gouni‐Berthold, Sonu Bhaskar, Agata Bielecka‐Dąbrowa, Bojko Bjelaković, Éric Bruckert, Ibadete Bytyçi, Alberto Cafferata, Richard Češka, Arrigo F.G. Cicero, Krzysztof Chlebus, Xavier Collet, Magdalena Daccord, Olivier Descamps, Dragan Djurić, Ronen Durst, М. В. Ежов, Zlatko Fras, Dan Gaiță, Ioanna Gouni‐Berthold, Adrían V. Hernández, Steven R. Jones, Jacek Jerzy Jozwiak, N. Kakauridze, Amani Kallel, Niki Katsiki, Amit Khera, Karam Kostner, Raimondas Kubilius, Gustavs Latkovskis, G.B. John Mancini, A. David Marais, Seth S. Martin, Julio Acosta Martínez, Mohsen Mazidi, Dimitri P. Mikhailidis, Erkin М Мirrakhimov, André R. Miserez, Olena Mitchenko, N. P. Mitкоvsкаyа, Patrick M. Moriarty, Seyed Mohammad Nabavi, Devaki Nair, Demosthenes B. Panagiotakos, György Paragh, Daniel Pella, Peter E. Penson, Žaneta Petrulionienė, Matteo Pirro, Arman Postadzhiyan, Raman Puri, Ashraf Reda, Željko Reiner, Dina Radenković, Michał Rakowski, Jemaa Riadh, Dimitri Richter, Manfredi Rizzo, Massimiliano Ruscica, Amirhossein Sahebkar, Maria-Corina Șerban, Abdullah Shehab, Aleksandr B. Shek, Cesare R. Sirtori, Claudia Stefanutti, Tomasz Tomasik, Peter P. Tóth, Margus Viigimaa, Pedro Valdivielso, Dragoş Vinereanu, Branislav Vohnout, Stephan von Haehling, Michal Vrablı́k, Nathan D. Wong, Hung‐I Yeh, Jiang Zhisheng, Andreas Zirlik
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease. The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.