Current Evidence for single interventions for the management of NAFLD to inform naturopathic practice: A narrative review

By Maya Harish - Online MSc - Advanced Complementary Medicine

Abstract

Background

Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common liver disorder in the developed world. Currently, no conventional treatment beyond weight loss is available and not all NAFLD patients are obese. Patients may consult naturopaths for support. However, the evidence base for naturopathic interventions for NAFLD is weak.

Aim

This study aimed to determine the current evidence regarding the therapeutic effect of single naturopathic interventions, using nutrition, herbal medicine, supplements or lifestyle changes, on obese/non-obese adults with NAFLD.

Methodology

A narrative review was undertaken, involving a comprehensive literature search of randomised controlled trials published in English over the last 5 years, using keywords within five medical literature databases: PubMed, MEDLINE, Clinical Key, Science Direct and Cochrane Library. Duplicates were eliminated, abstracts screened and full papers identified for judging eligibility according to strict inclusion/exclusion criteria. Adults on medication and/or with co-morbidities were excluded. Selected papers were subjected to critical appraisal (CASP) prior to synthesis for the narrative review.

Findings

Twenty-three papers were identified and included in the review: six involved herbal medicine covering five interventions, eleven involved seven different supplements, five discussed nutritional interventions, and two considered lifestyle interventions. Only two interventions (vitamin D and Zataria multiflora)produced no evidence of effect on NAFLD patients. All the others demonstrated improvement in outcome measures (mainly liver enzymes). Issues that arose included bio-availability and quality of products used. All four therapeutic groups offered some promising results and avenues for future research, despite relatively small sample sizes. CASP assessments showed most papers to be of moderately good quality.

Conclusion

This review offered some support for the benefits of single interventions used by naturopaths in the management of NAFLD. However, findings were preliminary rather than conclusive. There is a need for further research to confirm these findings regarding single interventions, as well as the potential benefits of combining them.