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Meta-Analysis
. 2024 Jan 10;82(2):143-165.
doi: 10.1093/nutrit/nuad054.

A systematic review and meta-analysis of randomized controlled trials to evaluate plant-based omega-3 polyunsaturated fatty acids in nonalcoholic fatty liver disease patient biomarkers and parameters

Ella Moore  1 , Imran Patanwala  2 , Alireza Jafari  3 , Ian G Davies  1 , Richard P Kirwan  1 , Lisa Newson  4 , Mohsen Mazidi  5   6 , Katie E Lane  1
Affiliations
Meta-Analysis

A systematic review and meta-analysis of randomized controlled trials to evaluate plant-based omega-3 polyunsaturated fatty acids in nonalcoholic fatty liver disease patient biomarkers and parameters

Ella Moore et al. Nutr Rev. .

Abstract

Context: Nonalcoholic fatty liver disease (NAFLD) is prevalent in 25-30% of British and European populations, representing a potential global public health crisis. Marine omega-3 (n-3) polyunsaturated fatty acids offer well-evidenced benefits to NAFLD biomarkers; however, the effect of plant-based n-3 has not been evaluated with a systematic review and meta-analysis.

Objective: The review aimed to systematically evaluate the effect of plant-based n-3 supplementation on NAFLD surrogate biomarkers and parameters.

Data sources: Medline (EBSCO), PubMed, CINAHL (EBSCO), Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform, and Google Scholar databases were searched to identify randomized controlled trials published between January 1970 and March 2022 evaluating the impact of plant-based n-3 interventions on diagnosed NAFLD. The review followed the PRISMA checklist and is PROSPERO registered (CRD42021251980).

Data extraction: A random-effects model and generic inverse variance methods synthesized quantitative data, followed by a leave-one-out method for sensitivity analysis. We identified 986 articles; after the application of selection criteria, six studies remained with 362 patients with NAFLD.

Results: The meta-analysis showed that plant-based n-3 fatty acid supplementation significantly reduced alanine aminotransferase (ALT) (mean difference: 8.04 IU/L; 95% confidence interval: 14.70, 1.38; I2 = 48.61%) and plasma/serum triglycerides (44.51 mg/dL; 95% confidence interval: -76.93, -12.08; I2 = 69.93%), alongside body-composition markers in patients with NAFLD (P < 0.05).

Conclusion: Plant-based n-3 fatty acid supplementation improves ALT enzyme biomarkers, triglycerides, body mass index, waist circumference, and weight loss when combined with lifestyle interventions to increase physical activity and a calorie-controlled diet. Further research is needed to identify the most effective plant-based n-3 sources in larger numbers of patients with NAFLD over longer study durations.

Systematic review registration: PROSPERO registration no. CRD42021251980.

Keywords: nonalcoholic fatty liver disease; omega-3; plant-based; supplementation.

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Figures

Figure 1
Figure 1
PRISMA flow diagram. Abbreviations: CCRCT, Cochrane Central Register of Controlled Trials; ICTRP, International Clinical Trials Registry Platform; NAFLD, nonalcoholic fatty liver disease; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Risk-of-bias graph: authors’ judgments for each risk-of-bias item are presented as percentages across all included studies.
Figure 3
Figure 3
Risk-of-bias summary for the included studies.
Figure 4A
Figure 4A
Forest plot of differences in alanine aminotransferase between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 4B
Figure 4B
Forest plot of differences in aspartate aminotransferase between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 4C
Figure 4C
Forest plot of differences in γ-glutamyl transferase between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 5A
Figure 5A
Forest plot of differences in blood glucose between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 5B
Figure 5B
Forest plot of differences in insulin between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 5C
Figure 5C
Forest plot of differences in homeostatic model of insulin resistance between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 6A
Figure 6A
Forest plot of differences in total cholesterol between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 6B
Figure 6B
Forest plot of differences in high-density-lipoprotein cholesterol between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 6C
Figure 6C
Forest plot of differences in low-density-lipoprotein cholesterol between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 6D
Figure 6D
Forest plot of differences in triglycerides between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 7
Figure 7
Forest plot of differences in high-sensitivity C-reactive protein between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 8A
Figure 8A
Forest plot of differences in body mass index between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 8B
Figure 8B
Forest plot of differences in waist circumference between n-3 and placebo arms. Abbreviation: CI, confidence interval.
Figure 8C
Figure 8C
Forest plot of differences in weight loss between n-3 and placebo arms. Abbreviation: CI, confidence interval.
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References

    1. Lazarus JV, Mark HE, Anstee QM, et al. ; NAFLD Consensus Consortium.Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol. 2022;19:60–78. doi: 10.1038/s41575-021-00523-4. - DOI - PubMed
    1. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. doi: 10.1002/hep.28431. - DOI - PubMed
    1. Mitra S, De A, Chowdhury A.. Epidemiology of non-alcoholic and alcoholic fatty liver diseases. Transl Gastroenterol Hepatol. 2020;5:16–16. doi: 10.21037/tgh.2019.09.08. - DOI - PMC - PubMed
    1. Scorletti E, Byrne CD.. Omega-3 fatty acids and non-alcoholic fatty liver disease: evidence of efficacy and mechanism of action. Mol Aspects Med. 2018;64:135–146. doi: 10.1016/j.mam.2018.03.001. - DOI - PubMed
    1. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64:1388–1402. doi: 10.1016/j.jhep.2015.11.004. - DOI - PubMed

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