Effectiveness of Omega-3 Polyunsaturated Fatty Acids in Non-Alcoholic Fatty Liver Disease: A Meta-Analysis of Randomized Controlled Trials

• Published in: PloS one Vol. 11; no. 10; p. e0162368
• Main Authors: He, Xi-Xi, Wu, Xiao-Li, Chen, Ren-Pin, Chen, Chao, Liu, Xiao-Gang, Wu, Bin-Jiao, Huang, Zhi-Ming
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.10.2016; Public Library of Science (PLoS)
• Subjects: Alanine; Alanine transaminase; Alcohol use; Analysis; Aspartate; Aspartate aminotransferase; Biology and Life Sciences; Blood Glucose - metabolism; Care and treatment; Cholesterol; Cirrhosis; Clinical trials; Confidence intervals; Cytokines; Demographics; Demography; Diabetes; Diet; Disease control; Fasting - blood; Fatty acids; Fatty Acids, Omega-3 - pharmacology; Fatty Acids, Omega-3 - therapeutic use; Fatty liver; Fibrosis; Fish oils; Gastroenterology; Hepatocellular carcinoma; Hepatocytes; High density lipoprotein; Hospitals; Humans; Identification methods; Insulin resistance; Intervention; Lipids - blood; Lipoproteins (high density); Lipoproteins (low density); Liver; Liver cancer; Liver cirrhosis; Liver diseases; Low density lipoprotein; Low density lipoproteins; Medicine and Health Sciences; Meta-analysis; Metabolic syndrome; Non-alcoholic Fatty Liver Disease - blood; Non-alcoholic Fatty Liver Disease - drug therapy; Non-alcoholic Fatty Liver Disease - enzymology; Patients; Physical Sciences; Polyunsaturated fatty acids; Quality assessment; Randomization; Randomized Controlled Trials as Topic - methods; Research and Analysis Methods; Rodents; Supplementation; Supplements; Triglycerides; Unsaturated fatty acids; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0162368

Non-alcoholic fatty liver disease (NAFLD) is a clinical syndrome with the main characteristic of diffuse liver cells with fatty changes. The clinical evolution of NAFLD includes simple non-alcoholic fatty liver, non-alcoholic steatohepatitis (NASH), liver fibrosis and cirrhosis, and even hepatocellular carcinoma. We conducted this review to identify the effectiveness of omega-3 polyunsaturated fatty acids (ω-3 PUFA) in NAFLD. We searched PubMed, Cochrane Library and Embase. All randomized controlled trials (RCTs) of ω-3 PUFA treatment for NAFLD were considered. Two reviewers assessed the quality of each study and collected data independently. Disagreements were resolved by discussion among the reviewers and any of the other authors of the paper. We performed a meta-analysis and reported summary estimates of outcomes as inverse variance (IV), fixed or random, with 95% confidence intervals (CIs). We included seven RCTs involving 442 patients (227 for the experimental group and 215 for the control group). All the patients were divided into two groups: one treated with ω-3 PUFA and the other was the control group (generally placebo). The demographics of the ω-3 PUFA and control groups were comparable. Beneficial changes in alanine aminotransferase (ALT) (IV 95% CI: -7.61 [-12.83 to -2.39], p = 0.004), total cholesterol (TC) (IV 95% CI: -13.41 [-21.44 to -5.38], p = 0.001), triglyceride (TG) (IV 95% CI: -43.96 [-51.21 to -36.71], p<0.00001) and high-density lipoprotein cholesterol (HDL-C) (IV 95% CI: 6.97 [2.05 to 11.90], p = 0.006) favored ω-3 PUFA treatment. Omega-3 PUFA tended towards a beneficial effect on aspartate aminotransferase (AST) (IV 95% CI: -6.89 [-17.71 to 3.92], p = 0.21), γ-glutamyl transferase (GGT) (IV 95% CI: -8.28 [-18.38 to 1.83], p = 0.11) and low-density lipoprotein cholesterol (LDL-C) (IV 95% CI: -7.13 [-14.26 to 0.0], p = 0.05). Supplementation with ω-3 PUFA is a practical and effective treatment for NAFLD to decrease ALT, TC and increase HDL-C, especially to decrease TG. Omega-3 PUFA also has a tendency toward a beneficial effect on AST, GGT and LDL-C. More high-quality, large RCTs are needed to validate our findings.