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Meta-Analysis
. 2023 Jan 31;15(3):721.
doi: 10.3390/nu15030721.

The Efficacy of Panax ginseng for the Treatment of Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Preclinical Studies

Keungmo Yang  1 , Hee-Hoon Kim  2 , Young-Ri Shim  2 , Myeong Jun Song  1
Affiliations
Meta-Analysis

The Efficacy of Panax ginseng for the Treatment of Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Preclinical Studies

Keungmo Yang et al. Nutrients. .

Abstract

Although tremendous research has reported the protective effects of natural compounds in nonalcoholic fatty liver disease (NAFLD), there is still no approved drug. This study aimed to examine the efficacy of Panax ginseng in NAFLD in preclinical studies. A total of 41 studies were identified by searching the PubMed, Web of Science, and Cochrane Library databases. The methodological quality was assessed by the risk of bias tool from the Systematic Review Center for Laboratory Animal Experimentation. The standardized mean difference (SMD) with a 95% confidence interval was calculated, and the random effects model was used to examine overall efficacy or heterogeneity. The publication bias was analyzed by Egger's test. The results showed that Panax ginseng treatment significantly reduced the systemic levels of alanine aminotransferase (SMD: -2.15 IU/L; p < 0.0001), aspartate aminotransferase (SMD: -2.86 IU/L; p < 0.0001), triglyceride (SMD: -2.86 mg/dL; p < 0.0001), total cholesterol (SMD: -1.69 mg/dL; p < 0.0001), low-density lipoprotein (SMD: -1.46 mg/dL; p < 0.0001), and fasting glucose (SMD: -1.45 mg/dL; p < 0.0001) while increasing high-density lipoprotein (SMD: 1.22 mg/dL; p = 0.0002) in NAFLD regardless of animal models or species. These findings may suggest that Panax ginseng is a promising therapeutic agent for NAFLD treatment.

Keywords: Panax ginseng; dyslipidemia; glucose tolerance; liver injury; meta-analysis; nonalcoholic fatty liver disease.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the systematic literature search. NAFLD, nonalcoholic fatty liver disease.
Figure 2
Figure 2
Quality assessment of included studies based on the SYRCLE’s risk of bias tool. (A) A graph of the risk in the bias of included studies. (B) A summary of the risk of bias in the included studies [7,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58].
Figure 2
Figure 2
Quality assessment of included studies based on the SYRCLE’s risk of bias tool. (A) A graph of the risk in the bias of included studies. (B) A summary of the risk of bias in the included studies [7,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58].
Figure 3
Figure 3
The effect of Panax ginseng on the levels of liver injury markers in NAFLD-induced animals. Forest plots for comparison: (A) Alanine aminotransferase (ALT) levels [7,19,20,23,24,27,28,29,30,31,32,35,36,37,38,39,40,41,43,44,45,47,48,49,50,52,54,55,56,58]. (B) Aspartate aminotransferase (AST) levels [19,23,27,28,29,30,31,32,35,36,37,38,39,40,41,44,45,47,48,49,50,52,54,55,56,58]. SD, standard deviation.
Figure 4
Figure 4
The effect of Panax ginseng on hepatic lipid metabolism in NAFLD-induced animals. Forest plots for comparison: (A) Triglyceride (TG) levels [7,19,20,21,22,23,24,25,26,27,28,29,30,32,33,34,35,38,39,40,41,44,46,47,48,49,50,51,52,56,58]. (B) Total cholesterol (TC) levels [7,19,20,21,23,25,26,27,28,29,30,32,33,34,35,38,39,40,41,44,46,47,49,50,51,52,56,57,58]. (C) High-density lipoprotein (HDL) levels [7,19,21,23,27,28,32,35,38,39,44,46,49,50,51,52,56,58]. (D) Low-density lipoprotein (LDL) levels [7,19,21,25,27,28,30,32,35,38,39,46,49,50,51,52,56,57,58]. SD, standard deviation.
Figure 4
Figure 4
The effect of Panax ginseng on hepatic lipid metabolism in NAFLD-induced animals. Forest plots for comparison: (A) Triglyceride (TG) levels [7,19,20,21,22,23,24,25,26,27,28,29,30,32,33,34,35,38,39,40,41,44,46,47,48,49,50,51,52,56,58]. (B) Total cholesterol (TC) levels [7,19,20,21,23,25,26,27,28,29,30,32,33,34,35,38,39,40,41,44,46,47,49,50,51,52,56,57,58]. (C) High-density lipoprotein (HDL) levels [7,19,21,23,27,28,32,35,38,39,44,46,49,50,51,52,56,58]. (D) Low-density lipoprotein (LDL) levels [7,19,21,25,27,28,30,32,35,38,39,46,49,50,51,52,56,57,58]. SD, standard deviation.
Figure 5
Figure 5
Effects of Panax ginseng on liver injury markers in the subgroup analysis of HFD-induced NAFLD. Forest plots for comparison: (A) ALT levels [7,26,27,28,30,32,35,36,37,39,40,41,47,48,49,52]. (B) AST levels [7,27,28,30,32,35,36,37,39,40,41,47,48,49,52]. SD, standard deviation.
Figure 6
Figure 6
Effects of Panax ginseng on markers for hepatic lipid metabolism in the subgroup analysis of HFD-induced NAFLD. Forest plots for comparison: (A) TG levels [7,21,22,25,26,27,28,30,32,33,34,35,39,40,41,46,47,48,49,51,52,57]. (B) TC levels [7,21,25,26,27,28,30,32,33,34,35,39,40,41,46,47,49,51,52,57]. (C) HDL levels [7,21,27,28,32,35,39,46,49,51,52]. (D) LDL levels [7,21,25,27,28,30,32,35,39,46,49,51,52,57]. SD, standard deviation.
Figure 7
Figure 7
Effects of Panax ginseng on NAFLD according to animal species. Bubble plots with the fitted meta-regression lines for comparison: (A) ALT levels [7,19,20,23,27,28,29,30,31,32,35,36,37,38,39,40,41,43,44,45,47,48,49,50,52,54,55,56,58]. (B) AST levels [19,23,27,28,29,30,31,32,35,36,37,38,39,40,41,44,45,47,48,49,50,52,54,55,56,58]. (C) TG levels [7,19,20,21,22,23,24,25,26,27,28,29,30,32,33,34,35,38,39,40,41,44,46,47,48,49,50,51,52,56,58]. (D) TC levels [7,19,20,21,23,25,26,27,28,29,30,32,33,34,35,38,39,40,41,44,46,47,49,50,51,52,56,57,58]. (E) HDL levels [7,19,21,23,27,28,32,35,38,39,44,46,49,50,51,52,56,58]. (F) LDL levels [7,19,21,25,27,28,30,32,35,38,39,46,49,50,51,52,56,57,58]. SD, standard deviation. Each circle indicates each study.
Figure 8
Figure 8
Effects of Panax ginseng on fasting blood glucose levels in NAFLD-induced animals. Forest plots for comparison: (A) All included studies [19,22,24,25,27,29,32,33,38,39,42,46,53,56]. (B) HFD-induced NAFLD subgroup analysis [22,25,27,32,33,39,46,53]. (C) A bubble plot with the fitted meta-regression line for the subgroup analysis according to animal species [19,22,24,25,27,29,32,33,38,39,42,46,53,56]. Each circle indicates each study. SD, standard deviation.
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