The efficacy and safety of acupuncture in nonalcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The aim of this study was to determine the efficacy and safety of acupuncture treatment (AT) or acupuncture plus conventional medicine (CM) versus CM alone using a meta-analysis of all published randomized controlled trials (RCTs) for nonalcoholic fatty liver disease (NAFLD).

Methods: Eight databases were searched independently from inception to April 30, 2020. RCTs were included if they contained reports on the use acupuncture or the use of acupuncture combined with CM and compared with the use of CM. Summary odds ratio (OR) and 95% confidence intervals (CIs) were used to calculate the overall clinical efficacy. Secondary outcomes, namely aspartate aminotransferase, alanine aminotransferase, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and body mass index, were calculated by mean difference with 95% CIs.

Results: After the final screening, 8 RCTs with 939 patients were included. This meta-analysis showed that AT was superior to CM in improving overall clinical efficacy (OR = 3.19, 95% CI: 2.06-4.92, P < .00001). In addition, AT plus CM could significantly improve overall clinical efficacy compared to treatment with CM alone (OR = 5.11, 95% CI: 2.43-10.75, P < .0001). Moreover, the benefits were also demonstrated in other outcomes, including alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol indexes. However, AT plus CM could not decrease body mass index levels in comparison with CM. The safety profile of Acupuncture therapy was satisfactory. Taichong, Zusanli, Fenglong, and Sanyinjiao were major acupoints on NAFLD treatment.

Conclusion: Acupuncture may be effective and safe for treatment of NAFLD. However, due to insufficient methodological quality and sample size, further high-quality studies are needed.

Figure 1

Flowchart of the trial selection process.

Figure 2

Risk of bias.

Figure 3

Summary of risk bias.

Figure 4

A) Efficacy of acupuncture on overall clinical efficacy. B) Efficacy of acupuncture plus conventional medicine on overall clinical efficacy. AT = acupuncture treatment, CI = confidence interval, CM = conventional medicine.

Figure 5

A) Efficacy of acupuncture on ALT. B) Efficacy of acupuncture plus conventional medicine on ALT. ALT = alanine aminotransferase, AT = acupuncture treatment, CI = confidence interval, CM = conventional medicine, EA = electroacupuncture, MA = manual acupuncture, SD = standard deviation, TET = thread embedding therapy.

Figure 6

A) Efficacy of acupuncture on AST. B) Efficacy of acupuncture plus conventional medicine on AST. AST = aspartate aminotransferase, AT = acupuncture treatment, CI = confidence interval, CM = conventional medicine, SD = standard deviation.

Figure 7

A) Efficacy of acupuncture on TC. B) Efficacy of acupuncture plus conventional medicine on TC. AT = acupuncture treatment, CI = confidence interval, CM = conventional medicine, EA = electroacupuncture, MA = manual acupuncture, SD = standard deviation, TC = total cholesterol.

Figure 8

A) Efficacy of acupuncture on TG. B) Efficacy of acupuncture plus conventional medicine on TG. AT = acupuncture treatment, CI = confidence interval, CM = conventional medicine, EA = electroacupuncture, MA = manual acupuncture, SD = standard deviation, TG = triglyceride.

Figure 9

A) Efficacy of acupuncture on HDL-C. B) Efficacy of acupuncture on LDL-C. AT = acupuncture treatment, CI = confidence interval, CM = conventional medicine, HDL-C = high-density lipoprotein cholesterol, SD = standard deviation.

Figure 10

Efficacy of acupuncture plus conventional medicine on BMI. AT = acupuncture treatment, BMI = body mass index, CI = confidence interval, CM = conventional medicine, SD = standard deviation.