The Effect of Silymarin on Liver Enzymes and Serum Lipid Profiles in Iranian Patients with Non-alcoholic fatty liver disease: A Double-blind Randomized Controlled Trial
Abstract
Objectives: The aim of this study was to evaluate the effect of silymarin on liver enzyme levels and serum lipid profiles in patients with Non-Alcoholic Fatty Liver Disease (NAFLD), the most common chronic liver disease worldwide.
Methods: This randomized double-blinded clinical trial included 80 NAFLD patients referred to the gastrointestinal clinic of Kowsar Hospital in Semnan. Forty of these patients were supplemented with 150 mg of silymarin twice a day for two months, while the other 40 received a placebo. Both groups were advised to follow a hypertriglyceridemia correction and lifestyle modification. Evaluation of serum lipid profiles and liver enzymes in both groups were performed at the baseline and after two months.
Results: The results showed that silymarin use significantly reduced ALT (U/L) (58.72±32.16 vs 42.2 ± 20.2, p = 0.003) and AST (U/L) (36.62± 13.46 vs 30.3 ± 9.7, p = 0.036) levels compared with the placebo group. Additionally, a statistically significant reducing effect of silymarin on triglycerides (mg/dL) (189.5 ± 65.5 vs 164.6 ± 91.3, p = 0.026), total cholesterol (mg/dL) (192.8 ± 40.3 vs 174.07± 34.5, p = 0.027), and LDL-cholesterol (mg/dL) (114.6±33.9 vs 95.6± 26.5, p = 0.012) levels was found, with no significant statistical difference for HDL-C (mg/dL) (41.5 ± 6.8 vs 43.5± 9.2, p = 0.44).
Conclusion: Silymarin, at a dose of 150 mg twice daily, significantly reduced liver enzymes and some lipid markers in patients with NAFLD, suggesting that this compound could be a novel therapy for NAFLD.
1. Smith, B.W. and L.A. Adams, Non-alcoholic fatty liver disease. Critical reviews in clinical laboratory sciences, 2011. 48(3): p. 97-113.
2. Perumpail, B.J., M.A. Khan, E.R. Yoo, G. Cholankeril, D. Kim, and A. Ahmed, Clinical epidemiology and disease burden of nonalcoholic fatty liver disease. World journal of gastroenterology, 2017. 23(47): p. 8263.
3. Williamson, R.M., J.F. Price, S. Glancy, E. Perry, L.D. Nee, P.C. Hayes, et al., Prevalence of and risk factors for hepatic steatosis and nonalcoholic fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes care, 2011. 34(5): p. 1139-1144.
4. Sattar Gorgani-Firuzjaee, R.M., Resveratrol reduces high glucose-induced de-novo lipogenesis through mTOR mediated induction of autophagy in HepG2 cells. Acta Biochimica Iranica, 2023. 1(1): p. 32-39.
5. Bellentani, S., F. Scaglioni, M. Marino, and G. Bedogni, Epidemiology of non-alcoholic fatty liver disease. Digestive diseases, 2010. 28(1): p. 155-161.
6. Nima Taghizadeh , S.M., Vahid Saeedi, Ladan Haghighi, Mona Nourbakhsh, Mitra Nourbakhsh, Maryam Razzaghy Azar, Association between Steroid Hormones and Insulin Resistance in Patients with Polycystic Ovary Syndrome. Acta Biochimica Iranica, 2023. 1: p. 1.
7. Perez-Guisado, J. and A. Munoz-Serrano, The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study. Journal of medicinal food, 2011. 14(7-8): p. 677-680.
8. Vernon, G., A. Baranova, and Z. Younossi, Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults. Alimentary pharmacology & therapeutics, 2011. 34(3): p. 274-285.
9. Ong, J.P., A. Pitts, and Z.M. Younossi, Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. Journal of hepatology, 2008. 49(4): p. 608-612.
10. Vuppalanchi, R. and N. Chalasani, Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management. Hepatology, 2009. 49(1): p. 306-317.
11. Ferguson, D. and B.N. Finck, Emerging therapeutic approaches for the treatment of NAFLD and type 2 diabetes mellitus. Nature Reviews Endocrinology, 2021. 17(8): p. 484-495.
12. Oliveira, C.P., P. de Lima Sanches, E.O. de Abreu-Silva, and A. Marcadenti, Nutrition and physical activity in nonalcoholic fatty liver disease. Journal of diabetes research, 2016. 2016.
13. Chalasani, N., Z. Younossi, J.E. Lavine, A.M. Diehl, E.M. Brunt, K. Cusi, et al., The diagnosis and management of non‐alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology, 2012. 55(6): p. 2005-2023.
14. Tehrani, S.S., G. Goodarzi, G. Panahi, F. Zamani-Garmsiri, and R. Meshkani, The combination of metformin with morin alleviates hepatic steatosis via modulating hepatic lipid metabolism, hepatic inflammation, brown adipose tissue thermogenesis, and white adipose tissue browning in high-fat diet-fed mice. Life Sciences, 2023. 323: p. 121706.
15. Golnaz Goodarzi, S.S.T., Ghodratollah Panahi, Arash Bahramzadeh, Reza Meshkani, Combination therapy of metformin and p-coumaric acid mitigates metabolic dysfunction associated with obesity and nonalcoholic fatty liver disease in high-fat diet obese C57BL/6 mice. The Journal of Nutritional Biochemistry, 2023. 118: p. 109369.
16. Chambers, C.S., V. Holečková, L. Petrásková, D. Biedermann, K. Valentová, M. Buchta, et al., The silymarin composition… and why does it matter??? Food research international, 2017. 100: p. 339-353.
17. MacDonald-Ramos, K., L. Michán, A. Martínez-Ibarra, and M. Cerbón, Silymarin is an ally against insulin resistance: A review. Annals of Hepatology, 2021. 23: p. 100255.
18. Lovelace, E.S., J. Wagoner, J. MacDonald, T. Bammler, J. Bruckner, J. Brownell, et al., Silymarin suppresses cellular inflammation by inducing reparative stress signaling. Journal of natural products, 2015. 78(8): p. 1990-2000.
19. Hosseinabadi, T., Z. Lorigooini, M. Tabarzad, B. Salehi, C.F. Rodrigues, N. Martins, et al., Silymarin antiproliferative and apoptotic effects: insights into its clinical impact in various types of cancer. Phytotherapy Research, 2019. 33(11): p. 2849-2861.
20. Gharbia, S., C. Balta, H. Herman, M. Rosu, J. Váradi, I. Bácskay, et al., Enhancement of silymarin anti-fibrotic effects by complexation with hydroxypropyl (HPBCD) and randomly methylated (RAMEB) β-cyclodextrins in a mouse model of liver fibrosis. Frontiers in Pharmacology, 2018. 9: p. 883.
21. El-Lakkany, N.M., O.A. Hammam, W.H. El-Maadawy, A.A. Badawy, A.A. Ain-Shoka, and F.A. Ebeid, Anti-inflammatory/anti-fibrotic effects of the hepatoprotective silymarin and the schistosomicide praziquantel against Schistosoma mansoni-induced liver fibrosis. Parasites & vectors, 2012. 5(1): p. 1-14.
22. Liu, C.-H., A. Jassey, H.-Y. Hsu, and L.-T. Lin, Antiviral activities of silymarin and derivatives. Molecules, 2019. 24(8): p. 1552.
23. AbouZid, S. and O.M. Ahmed, Silymarin flavonolignans: Structure–activity relationship and biosynthesis. Studies in natural products chemistry, 2013. 40: p. 469-484.
24. Famouri, F., M.-M. Salehi, N. Rostampour, E. Hashemi, and A. Shahsanaee, The effect of silymarin on non-alcoholic fatty liver disease of children. Journal of Herbmed Pharmacology, 2016. 6(1): p. 16-20.
25. Kalopitas, G., C. Antza, I. Doundoulakis, A. Siargkas, E. Kouroumalis, G. Germanidis, et al., The impact of silymarin in patients with non-alcoholic fatty liver disease: A systematic review and meta-Analysis. Clinical Nutrition ESPEN, 2020. 40: p. 515.
26. Aller, R., O. Izaola, S. Gómez, C. Tafur, G. González, E. Berroa, et al., Effect of silymarin plus vitamin E in patients with non-alcoholic fatty liver disease. A randomized clinical pilot study. Eur Rev Med Pharmacol Sci, 2015. 19(16): p. 3118-24.
27. Tighe, S.P., D. Akhtar, U. Iqbal, and A. Ahmed, Chronic liver disease and silymarin: A biochemical and clinical review. Journal of Clinical and Translational Hepatology, 2020. 8(4): p. 454.
28. Gillessen, A. and H.H.-J. Schmidt, Silymarin as supportive treatment in liver diseases: A narrative review. Advances in therapy, 2020. 37(4): p. 1279-1301.
29. Hajiaghamohammadi, A.A., A. Ziaee, S. Oveisi, and H.J.H.m. Masroor, Effects of metformin, pioglitazone, and silymarin treatment on non-alcoholic Fatty liver disease: a randomized controlled pilot study. 2012. 12(8).
30. King, M.T.J.E.r.o.p. and o. research, A point of minimal important difference (MID): a critique of terminology and methods. 2011. 11(2): p. 171-184.
31. Marcellin, P. and B.K. Kutala, Liver diseases: A major, neglected global public health problem requiring urgent actions and large‐scale screening. Liver International, 2018. 38: p. 2-6.
32. Benedict, M. and X. Zhang, Non-alcoholic fatty liver disease: An expanded review. World journal of hepatology, 2017. 9(16): p. 715.
33. Yaser Mohassel , S.A., Shayan Mostafae , Mohammad Taghi Goodarzi Assessing the Possible Association between Polymorphism of C677T MTHFR with Preeclampsia Risk: A Systematic Review and Bayesian Hierarchical Meta-Analysis. Acta Biochimica Iranica, 2023. 1(1): p. 3-11.
34. El-Agroudy, N.N., A. Kurzbach, R.N. Rodionov, J. O’Sullivan, M. Roden, A.L. Birkenfeld, et al., Are lifestyle therapies effective for NAFLD treatment? Trends in Endocrinology & Metabolism, 2019. 30(10): p. 701-709.
35. Mengesha, T., N. Gnanasekaran, T.J.B.c.m. Mehare, and therapies, Hepatoprotective effect of silymarin on fructose induced nonalcoholic fatty liver disease in male albino wistar rats. 2021. 21(1): p. 1-13.
36. Famouri, F., M.-M. Salehi, N. Rostampour, E. Hashemi, and A.J.J.o.H.P. Shahsanaee, The effect of silymarin on non-alcoholic fatty liver disease of children. 2016. 6(1): p. 16-20.
37. Shaker, E., H. Mahmoud, S.J.F. Mnaa, and C. Toxicology, Silymarin, the antioxidant component and Silybum marianum extracts prevent liver damage. 2010. 48(3): p. 803-806.
38. Gargari, B.P., M. Mobasseri, H. Valizadeh, and M.J.P. Asghari-Jafarabadi, Effects of Silybum marianum (L.) Gaertn.(silymarin) extract supplementation on antioxidant status and hs-CRP in patients with type 2 diabetes mellitus: a randomized, triple-blind, placebo-controlled clinical trial. 2015. 22(2): p. 290-296.
39. Hashemi, S.J., E. Hajiani, and S.E. HEYDARI, A placebo-controlled trial of silymarin in patients with nonalcoholic fatty liver disease. 2009.
40. HAJAGHA, M.A., A. ZIAEI, and R. Rafiei, The efficacy of silymarin in decreasing transaminase activities in non-alcoholic fatty liver disease: A randomized controlled clinical trial. 2008.
41. Masoodi, M., A. Rezadoost, M. Panahian, and M. Vojdanian, Effects of silymarin on reducing liver aminotransferases in patients with nonalcoholic fatty liver diseases. Govaresh, 2013. 18(3): p. 181-185.
42. Cacciapuoti, F., A. Scognamiglio, R. Palumbo, R. Forte, and F.J.W.j.o.h. Cacciapuoti, Silymarin in non alcoholic fatty liver disease. 2013. 5(3): p. 109.
43. Hajiani, E. and S.J. Hashemi, Comparison of therapeutic effects of silymarin and vitamin E in nonalcoholic fatty liver disease: results of an open-labele, prospective, randomized study. Jundishapur Journal of Natural Pharmaceutical Products, 2009. 4(1): p. 8-14.
44. Ebrahimpour-Koujan, S., B.P. Gargari, M. Mobasseri, H. Valizadeh, and M.J.P. Asghari-Jafarabadi, Lower glycemic indices and lipid profile among type 2 diabetes mellitus patients who received novel dose of Silybum marianum (L.) Gaertn.(silymarin) extract supplement: A Triple-blinded randomized controlled clinical trial. 2018. 44: p. 39-44.
45. Škottová, N., L. Kazdová, O. Oliyarnyk, R. Večeřa, L. Sobolová, and J.J.P.r. Ulrichová, Phenolics-rich extracts from Silybum marianum and Prunella vulgaris reduce a high-sucrose diet induced oxidative stress in hereditary hypertriglyceridemic rats. 2004. 50(2): p. 123-130.
46. Ozkaya, M., E. Cakal, Y. Ustun, Y.J.F. Engin-Ustun, and sterility, Effect of metformin on serum visfatin levels in patients with polycystic ovary syndrome. 2010. 93(3): p. 880-884.
47. CHOU, C.H., Y.C. CHEN, M.C. HSU, W.L. TSAI, C.Y. CHANG, and C.H.J.J.o.F.B. CHIU, Effect of silymarin on lipid and alcohol metabolism in mice following long‐term alcohol consumption. 2012. 36(3): p. 369-377.
48. Orolin, J., R. Večeřa, D. Jung, U. Meyer, N. Škottová, and P.J.X. Anzenbacher, Hypolipidemic effects of silymarin are not mediated by the peroxisome proliferator-activated receptor alpha. 2007. 37(7): p. 725-735.
49. Prakash, P., V. Singh, M. Jain, M. Rana, V. Khanna, M.K. Barthwal, et al., Silymarin ameliorates fructose induced insulin resistance syndrome by reducing de novo hepatic lipogenesis in the rat. 2014. 727: p. 15-28.
2. Perumpail, B.J., M.A. Khan, E.R. Yoo, G. Cholankeril, D. Kim, and A. Ahmed, Clinical epidemiology and disease burden of nonalcoholic fatty liver disease. World journal of gastroenterology, 2017. 23(47): p. 8263.
3. Williamson, R.M., J.F. Price, S. Glancy, E. Perry, L.D. Nee, P.C. Hayes, et al., Prevalence of and risk factors for hepatic steatosis and nonalcoholic fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes care, 2011. 34(5): p. 1139-1144.
4. Sattar Gorgani-Firuzjaee, R.M., Resveratrol reduces high glucose-induced de-novo lipogenesis through mTOR mediated induction of autophagy in HepG2 cells. Acta Biochimica Iranica, 2023. 1(1): p. 32-39.
5. Bellentani, S., F. Scaglioni, M. Marino, and G. Bedogni, Epidemiology of non-alcoholic fatty liver disease. Digestive diseases, 2010. 28(1): p. 155-161.
6. Nima Taghizadeh , S.M., Vahid Saeedi, Ladan Haghighi, Mona Nourbakhsh, Mitra Nourbakhsh, Maryam Razzaghy Azar, Association between Steroid Hormones and Insulin Resistance in Patients with Polycystic Ovary Syndrome. Acta Biochimica Iranica, 2023. 1: p. 1.
7. Perez-Guisado, J. and A. Munoz-Serrano, The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study. Journal of medicinal food, 2011. 14(7-8): p. 677-680.
8. Vernon, G., A. Baranova, and Z. Younossi, Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults. Alimentary pharmacology & therapeutics, 2011. 34(3): p. 274-285.
9. Ong, J.P., A. Pitts, and Z.M. Younossi, Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. Journal of hepatology, 2008. 49(4): p. 608-612.
10. Vuppalanchi, R. and N. Chalasani, Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management. Hepatology, 2009. 49(1): p. 306-317.
11. Ferguson, D. and B.N. Finck, Emerging therapeutic approaches for the treatment of NAFLD and type 2 diabetes mellitus. Nature Reviews Endocrinology, 2021. 17(8): p. 484-495.
12. Oliveira, C.P., P. de Lima Sanches, E.O. de Abreu-Silva, and A. Marcadenti, Nutrition and physical activity in nonalcoholic fatty liver disease. Journal of diabetes research, 2016. 2016.
13. Chalasani, N., Z. Younossi, J.E. Lavine, A.M. Diehl, E.M. Brunt, K. Cusi, et al., The diagnosis and management of non‐alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology, 2012. 55(6): p. 2005-2023.
14. Tehrani, S.S., G. Goodarzi, G. Panahi, F. Zamani-Garmsiri, and R. Meshkani, The combination of metformin with morin alleviates hepatic steatosis via modulating hepatic lipid metabolism, hepatic inflammation, brown adipose tissue thermogenesis, and white adipose tissue browning in high-fat diet-fed mice. Life Sciences, 2023. 323: p. 121706.
15. Golnaz Goodarzi, S.S.T., Ghodratollah Panahi, Arash Bahramzadeh, Reza Meshkani, Combination therapy of metformin and p-coumaric acid mitigates metabolic dysfunction associated with obesity and nonalcoholic fatty liver disease in high-fat diet obese C57BL/6 mice. The Journal of Nutritional Biochemistry, 2023. 118: p. 109369.
16. Chambers, C.S., V. Holečková, L. Petrásková, D. Biedermann, K. Valentová, M. Buchta, et al., The silymarin composition… and why does it matter??? Food research international, 2017. 100: p. 339-353.
17. MacDonald-Ramos, K., L. Michán, A. Martínez-Ibarra, and M. Cerbón, Silymarin is an ally against insulin resistance: A review. Annals of Hepatology, 2021. 23: p. 100255.
18. Lovelace, E.S., J. Wagoner, J. MacDonald, T. Bammler, J. Bruckner, J. Brownell, et al., Silymarin suppresses cellular inflammation by inducing reparative stress signaling. Journal of natural products, 2015. 78(8): p. 1990-2000.
19. Hosseinabadi, T., Z. Lorigooini, M. Tabarzad, B. Salehi, C.F. Rodrigues, N. Martins, et al., Silymarin antiproliferative and apoptotic effects: insights into its clinical impact in various types of cancer. Phytotherapy Research, 2019. 33(11): p. 2849-2861.
20. Gharbia, S., C. Balta, H. Herman, M. Rosu, J. Váradi, I. Bácskay, et al., Enhancement of silymarin anti-fibrotic effects by complexation with hydroxypropyl (HPBCD) and randomly methylated (RAMEB) β-cyclodextrins in a mouse model of liver fibrosis. Frontiers in Pharmacology, 2018. 9: p. 883.
21. El-Lakkany, N.M., O.A. Hammam, W.H. El-Maadawy, A.A. Badawy, A.A. Ain-Shoka, and F.A. Ebeid, Anti-inflammatory/anti-fibrotic effects of the hepatoprotective silymarin and the schistosomicide praziquantel against Schistosoma mansoni-induced liver fibrosis. Parasites & vectors, 2012. 5(1): p. 1-14.
22. Liu, C.-H., A. Jassey, H.-Y. Hsu, and L.-T. Lin, Antiviral activities of silymarin and derivatives. Molecules, 2019. 24(8): p. 1552.
23. AbouZid, S. and O.M. Ahmed, Silymarin flavonolignans: Structure–activity relationship and biosynthesis. Studies in natural products chemistry, 2013. 40: p. 469-484.
24. Famouri, F., M.-M. Salehi, N. Rostampour, E. Hashemi, and A. Shahsanaee, The effect of silymarin on non-alcoholic fatty liver disease of children. Journal of Herbmed Pharmacology, 2016. 6(1): p. 16-20.
25. Kalopitas, G., C. Antza, I. Doundoulakis, A. Siargkas, E. Kouroumalis, G. Germanidis, et al., The impact of silymarin in patients with non-alcoholic fatty liver disease: A systematic review and meta-Analysis. Clinical Nutrition ESPEN, 2020. 40: p. 515.
26. Aller, R., O. Izaola, S. Gómez, C. Tafur, G. González, E. Berroa, et al., Effect of silymarin plus vitamin E in patients with non-alcoholic fatty liver disease. A randomized clinical pilot study. Eur Rev Med Pharmacol Sci, 2015. 19(16): p. 3118-24.
27. Tighe, S.P., D. Akhtar, U. Iqbal, and A. Ahmed, Chronic liver disease and silymarin: A biochemical and clinical review. Journal of Clinical and Translational Hepatology, 2020. 8(4): p. 454.
28. Gillessen, A. and H.H.-J. Schmidt, Silymarin as supportive treatment in liver diseases: A narrative review. Advances in therapy, 2020. 37(4): p. 1279-1301.
29. Hajiaghamohammadi, A.A., A. Ziaee, S. Oveisi, and H.J.H.m. Masroor, Effects of metformin, pioglitazone, and silymarin treatment on non-alcoholic Fatty liver disease: a randomized controlled pilot study. 2012. 12(8).
30. King, M.T.J.E.r.o.p. and o. research, A point of minimal important difference (MID): a critique of terminology and methods. 2011. 11(2): p. 171-184.
31. Marcellin, P. and B.K. Kutala, Liver diseases: A major, neglected global public health problem requiring urgent actions and large‐scale screening. Liver International, 2018. 38: p. 2-6.
32. Benedict, M. and X. Zhang, Non-alcoholic fatty liver disease: An expanded review. World journal of hepatology, 2017. 9(16): p. 715.
33. Yaser Mohassel , S.A., Shayan Mostafae , Mohammad Taghi Goodarzi Assessing the Possible Association between Polymorphism of C677T MTHFR with Preeclampsia Risk: A Systematic Review and Bayesian Hierarchical Meta-Analysis. Acta Biochimica Iranica, 2023. 1(1): p. 3-11.
34. El-Agroudy, N.N., A. Kurzbach, R.N. Rodionov, J. O’Sullivan, M. Roden, A.L. Birkenfeld, et al., Are lifestyle therapies effective for NAFLD treatment? Trends in Endocrinology & Metabolism, 2019. 30(10): p. 701-709.
35. Mengesha, T., N. Gnanasekaran, T.J.B.c.m. Mehare, and therapies, Hepatoprotective effect of silymarin on fructose induced nonalcoholic fatty liver disease in male albino wistar rats. 2021. 21(1): p. 1-13.
36. Famouri, F., M.-M. Salehi, N. Rostampour, E. Hashemi, and A.J.J.o.H.P. Shahsanaee, The effect of silymarin on non-alcoholic fatty liver disease of children. 2016. 6(1): p. 16-20.
37. Shaker, E., H. Mahmoud, S.J.F. Mnaa, and C. Toxicology, Silymarin, the antioxidant component and Silybum marianum extracts prevent liver damage. 2010. 48(3): p. 803-806.
38. Gargari, B.P., M. Mobasseri, H. Valizadeh, and M.J.P. Asghari-Jafarabadi, Effects of Silybum marianum (L.) Gaertn.(silymarin) extract supplementation on antioxidant status and hs-CRP in patients with type 2 diabetes mellitus: a randomized, triple-blind, placebo-controlled clinical trial. 2015. 22(2): p. 290-296.
39. Hashemi, S.J., E. Hajiani, and S.E. HEYDARI, A placebo-controlled trial of silymarin in patients with nonalcoholic fatty liver disease. 2009.
40. HAJAGHA, M.A., A. ZIAEI, and R. Rafiei, The efficacy of silymarin in decreasing transaminase activities in non-alcoholic fatty liver disease: A randomized controlled clinical trial. 2008.
41. Masoodi, M., A. Rezadoost, M. Panahian, and M. Vojdanian, Effects of silymarin on reducing liver aminotransferases in patients with nonalcoholic fatty liver diseases. Govaresh, 2013. 18(3): p. 181-185.
42. Cacciapuoti, F., A. Scognamiglio, R. Palumbo, R. Forte, and F.J.W.j.o.h. Cacciapuoti, Silymarin in non alcoholic fatty liver disease. 2013. 5(3): p. 109.
43. Hajiani, E. and S.J. Hashemi, Comparison of therapeutic effects of silymarin and vitamin E in nonalcoholic fatty liver disease: results of an open-labele, prospective, randomized study. Jundishapur Journal of Natural Pharmaceutical Products, 2009. 4(1): p. 8-14.
44. Ebrahimpour-Koujan, S., B.P. Gargari, M. Mobasseri, H. Valizadeh, and M.J.P. Asghari-Jafarabadi, Lower glycemic indices and lipid profile among type 2 diabetes mellitus patients who received novel dose of Silybum marianum (L.) Gaertn.(silymarin) extract supplement: A Triple-blinded randomized controlled clinical trial. 2018. 44: p. 39-44.
45. Škottová, N., L. Kazdová, O. Oliyarnyk, R. Večeřa, L. Sobolová, and J.J.P.r. Ulrichová, Phenolics-rich extracts from Silybum marianum and Prunella vulgaris reduce a high-sucrose diet induced oxidative stress in hereditary hypertriglyceridemic rats. 2004. 50(2): p. 123-130.
46. Ozkaya, M., E. Cakal, Y. Ustun, Y.J.F. Engin-Ustun, and sterility, Effect of metformin on serum visfatin levels in patients with polycystic ovary syndrome. 2010. 93(3): p. 880-884.
47. CHOU, C.H., Y.C. CHEN, M.C. HSU, W.L. TSAI, C.Y. CHANG, and C.H.J.J.o.F.B. CHIU, Effect of silymarin on lipid and alcohol metabolism in mice following long‐term alcohol consumption. 2012. 36(3): p. 369-377.
48. Orolin, J., R. Večeřa, D. Jung, U. Meyer, N. Škottová, and P.J.X. Anzenbacher, Hypolipidemic effects of silymarin are not mediated by the peroxisome proliferator-activated receptor alpha. 2007. 37(7): p. 725-735.
49. Prakash, P., V. Singh, M. Jain, M. Rana, V. Khanna, M.K. Barthwal, et al., Silymarin ameliorates fructose induced insulin resistance syndrome by reducing de novo hepatic lipogenesis in the rat. 2014. 727: p. 15-28.
| Files | ||
| Issue | Vol 1 No 2 (2023) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/abi.v1i2.14105 | |
| Keywords | ||
| Silymarin Fatty liver Non-alcoholic Fatty Liver Disease NAFLD | ||
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How to Cite
1.
Chahkandi S, Dabiri R, Mirmohammadkhani M, Amiri-Dashatan N, Koushki M. The Effect of Silymarin on Liver Enzymes and Serum Lipid Profiles in Iranian Patients with Non-alcoholic fatty liver disease: A Double-blind Randomized Controlled Trial. ABI. 2023;1(2):83-89.
