Non-alcoholic fatty liver disease (NAFLD) is an obesity-related metabolic liver disorder that is increasing in prevalence. The Australian population is expected to experience substantial increases in NAFLD‐related disease burden in the coming decades. NAFLD is defined as the presence of excessive liver fat in the absence of other causes such as excess alcohol. The cause of NAFLD is complicated and involves lifestyle, nutritional factors, lipogenesis (the metabolic formation of fat), cell death, chronic low-grade inflammatory response and an altered gut microbiome. It has been associated with obesity, insulin resistance, type 2 diabetes, high cholesterol, high blood pressure and cardiovascular disease. Australian researchers say intervention is needed to slow the growth in obesity and metabolic syndrome. “Both lifestyle modifications and other therapeutic options must be considered to avert the coming epidemic of NAFLD‐related liver disease,” they say. Currently there are no approved drugs to specifically target or treat NAFLD. The recommended treatment is weight loss, achieved through change in dietary and physical activity behaviours, which can reduce liver fat, inflammation and fibrosis. The Mediterranean diet has been effective in reducing metabolic syndrome and cardiovascular risk factors, as well as NAFLD improvement by reduction of the severity of hepatic steatosis (fatty liver). A plant-based diet, with significant fibre, antioxidants, vegetable proteins, polyunsaturated and monounsaturated fat (nuts and seeds, fish, olive oil) has been emphasised.
Studies in recent years have revealed that some medicinal plants could be thought of as a substitute for traditional NAFLD management methods. In relation to this the results from the first study of its kind, an Iranian randomised double-blind clinical trial published in August (2023), concluded that 1500mg (the dose was calculated from a related animal study which reported promising results) of pomegranate peel extract, along with a weight-loss diet, improved metabolic syndrome risk factors and reduced fatty liver in patients with NAFLD after eight weeks. Evidence shows that antioxidants in pomegranate peel act synergistically as a strong antioxidant network that causes various beneficial effects. In addition to its antioxidant properties recent studies show that pomegranate peel could be a promising candidate for the treatment of NAFLD by maintaining the balance of the microbiome of the digestive system and influencing the expression of key genes in the pathways of inflammation and liver lipogenesis and inhibiting the signalling pathways in liver fibrogenesis (the abnormal accumulation of fibrous tissue).
In the trial, NAFLD patients received 1500mg of placebo (37 people) or pomegranate peel capsules (39 people) with a 500-calorie deficit diet (consuming 500 fewer calories than they normally do on a day-to-day basis) for eight weeks. Following the intervention the mean body weight, waist circumference, body mass index, body fat index and trunk fat, systolic and diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol, fat free mass and fasting blood sugar decreased significantly in the pomegranate group in contrast to the placebo group. Also, high-density lipoprotein cholesterol, liver steatosis and stiffness improved in the pomegranate group.
References
Adams LA, Roberts SK, Strasser SI, Mahady SE, Powell E, Estes C, Razavi H, George J. Nonalcoholic fatty liver disease burden: Australia, 2019-2030. J Gastroenterol Hepatol. 2020 Sep;35(9):1628-1635. doi: 10.1111/jgh.15009. Epub 2020 Feb 26. PMID: 32048317; PMCID: PMC7540570.
Barghchi H, Milkarizi N, Belyani S, Norouzian Ostad A, Askari VR, Rajabzadeh F, Goshayeshi L, Ghelichi Kheyrabadi SY, Razavidarmian M, Dehnavi Z, Sobhani SR, Nematy M. Pomegranate (Punica granatum L.) peel extract ameliorates metabolic syndrome risk factors in patients with non-alcoholic fatty liver disease: a randomized double-blind clinical trial. Nutr J. 2023 Aug 22;22(1):40. doi: 10.1186/s12937-023-00869-2. PMID: 37605174; PMCID: PMC10464300.
Barghchi H, Milkarizi N, Belyani S, Norouzian Ostad A, Askari VR, Rajabzadeh F, Goshayeshi L, Ghelichi Kheyrabadi SY, Razavidarmian M, Dehnavi Z, Sobhani SR, Nematy M. Pomegranate (Punica granatum L.) peel extract ameliorates metabolic syndrome risk factors in patients with non-alcoholic fatty liver disease: a randomized double-blind clinical trial. Nutr J. 2023 Aug 22;22(1):40. doi: 10.1186/s12937-023-00869-2. PMID: 37605174; PMCID: PMC10464300.
Barghchi H, Milkarizi N, Belyani S, Norouzian Ostad A, Askari VR, Rajabzadeh F, Goshayeshi L, Ghelichi Kheyrabadi SY, Razavidarmian M, Dehnavi Z, Sobhani SR, Nematy M. Pomegranate (Punica granatum L.) peel extract ameliorates metabolic syndrome risk factors in patients with non-alcoholic fatty liver disease: a randomized double-blind clinical trial. Nutr J. 2023 Aug 22;22(1):40. doi: 10.1186/s12937-023-00869-2. PMID: 37605174; PMCID: PMC10464300.
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