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

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver ailment globally, remains a significant concern. Acupuncture has been increasingly utilized for the treatment of NAFLD in recent years. However, current evidence is insufficient to support its efficacy and safety. The aim of this study was to perform a recent and thorough meta-analysis concerning the impacts of acupuncture on NAFLD.

Methods: Randomized controlled trials (RCTs) investigating acupuncture for NAFLD were retrieved from 6 databases. The search encompassed the period from the inception of each database until February 28, 2024. We conducted literature screening based on predefined inclusion and exclusion criteria, resulting in the selection of 30 articles. Analysis of the data was carried out utilizing Review Manager 5.4 and Stata 15.1.

Results: The meta-analysis revealed a marked enhancement in the overall clinical effectiveness rate within the acupuncture group in comparison to the control group (OR = 3.36; 95% CI:2.62 to 4.31; P < .00001, I2 = 0%). Acupuncture exhibited positive impact on liver function recovery, blood lipid reduction, glucose regulation, improvement in insulin levels, antiliver fibrosis treatment, and imaging outcomes. Comprehensive analysis revealed that acupoint embedding (OR = 3.14; 95% CI: 2.113 to 4.62; P < .00001, I2 = 0%) demonstrated the most effective and stable therapeutic effect, followed by manual acupuncture (MA) (OR = 3.27; 95% CI: 2.19 to 4.90; P < .00001, I2 = 0%) and electroacupuncture (EA) (OR = 3.32; 95% CI: 1.69 to 6.52; P < .0005, I2 = 0%). In contrast, acupoint injection (AI) (OR = 5.74; 95% CI: 2.23 to 14.883; P < .0003, I2 = 0%) exhibited relatively modest effects, particularly in lipid reduction. No significant adverse reactions were observed with acupuncture treatments.

Conclusion: Acupuncture has demonstrated safety and efficacy in the treatment of NAFLD, significantly improving hepatic function, lowering glucose and lipid levels, and mitigating liver fibrosis. Nevertheless, these findings necessitate validation through large-scale, rigorously designed randomized controlled trials.

Keywords: acupuncture; meta-analysis; nonalcoholic fatty liver disease; randomized controlled trials; systematic review.

Figure 1.

Flowchart of the systematic search and selection process.

Figure 2.

Risk of bias assessment. (A) Risk of bias graph. (B) Risk of bias summary.

Figure 3.

Forest plots of outcomes. (A) Overall clinical efficacy, (B) AST, (C) ALT, (D) GGT, (E) TC, (F) TG. ALT = alanine aminotransferase, AST = aspartate aminotransferase, GGT = γ-glutamyl transpeptadase, TC = total cholesterol, TG = triglyceride.

Figure 4.

Forest plots of outcomes. (A) HDL, (B) LDL, (C) FPG, (D) FINS, (E) HOMA-IR, (F) PCIII, (G) LN, (H) HA. FINS = fasting insulin, FPG = fasting plasma glucose, HA = hyaluronic acid, HDL = high-density lipoprotein, HOMA-IR = homestasis model assessment of insulin, LDL = low-density lipoprotein, LN = laminin, PCIII = procollagen Type III.

Figure 5.

Forest plots of outcomes. (A) CIV, (B) ultrasound efficiency, (C) liver and spleen CT ratio, (D) BMI. BMI = body mass index, CIV = collagen Type IV.

Figure 6.

Funnel plots of (A) overall clinical efficacy, (B) AST, (C) ALT, (D) GGT, (E) TC, (F) TG, (G) HDL, (H) LDL, (I) FPG. ALT = alanine aminotransferase, AST = aspartate aminotransferase, FPG = fasting plasma glucose, GGT = γ-glutamyl transpeptadase, HDL = high-density lipoprotein, LDL = low-density lipoprotein, TC = total cholesterol, TG = triglyceride.

Figure 7.

Funnel plots of (A) FINS, (B) HOMA-IR, (C) PCIII, (D) LN, (E) HA, (F) CIV, (G) ultrasound efficiency, (H) liver and spleen CT ratio, (I) BMI. BMI = body mass index, CIV = collagen Type IV, FINS = fasting insulin, HA = hyaluronic acid, HOMA-IR = homestasis model assessment of insulin, LN = laminin, PCIII = procollagen Type III.

Figure 8.

Sensitivity analysis. (A) Overall clinical efficacy, (B) AST, (C) ALT, (D) GGT, (E) TC, (F) TG, (G) ultrasound efficiency, (H) BMI. ALT = alanine aminotransferase, AST = aspartate aminotransferase, BMI = body mass index, GGT = γ-glutamyl transpeptadase, TC = total cholesterol, TG = triglyceride.