NAFLD

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• Definition
• Introduction
• Signs & Symptoms
• Research Summary

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Executive Summary

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Write an executive summary in the form of a blog article on the topic of "Research into Chinese medicine treatment for NAFLD" summarising the research below and using language that can be easily understood by patients and avoiding medical jargon using a professional and caring tone of voice.

Write an executive summary in the form of a blog article on the topic of "Researched Chinese medicine treatments for NAFLD" summarising the research below in an objective and easy to understand way, and using language that can be easily understood by patients. Group the article into Chinese medicine treatments first, followed by nutrition and other treatments. Avoid using medical jargon and use a professional and caring tone of voice.

Write me a concise but easy to understand executive summary on the topic of "Chinese medicine treatments for NAFLD" based on the following research that I will give you. Your summary should be 2 paragraphs long in Australian English spelling and include references to the studies.

A Randomised Controlled Trial published in 2023 in the journal Nutrition Journal found that Pomegranate peel extract, along with a calorie deficit diet, could improve risk factors of metabolic syndrome and reduce fatty liver in patients with non-alcoholic fatty liver disease. In the first phase, the research involved the hydro-alcoholic extraction of the peel of 750 kilograms of pomegranate using the soaking method. The second phase saw patients with non-alcoholic fatty liver disease divided into two groups - a placebo group and a pomegranate peel capsule group. Both groups followed a diet with a 500 kcal deficit for eight weeks. Aspects like intolerance to the treatment, participants' dietary intake, their lipid and glycemic profiles, blood pressure, body composition, insulin resistance indexes and changes in fatty liver disease evaluated through elastography were monitored. Further, the study reported substantial decreases in multiple indicators such as body weight, waist circumference, body mass index, body fat index, trunk fat, blood pressure, total cholesterol, triglyceride levels, LDL cholesterol, fat free mass, and fasting blood sugar in the group that took pomegranate peel capsules compared to the placebo group. Meanwhile, HDL cholesterol and liver steatosis and stiffness saw improvement. No significant differences, however, were found in the insulin and homeostatic model assessment for insulin resistance between the two groups.

A Review Article published in 2023 in the journal Critical Reviews in Food Science and Nutrition found that Theabrownins, a major ingredient in dark tea, significantly contribute to multiple health benefits by modulating lipid metabolism, reducing weight gain, and preventing diseases, surpassing other tea types. The research focuses on theabrownins, macromolecular pigments found in dark tea, believed to have numerous health benefits. These pigments derive from the oxidative polymerization of tea polyphenols and are observed to have a reddish-brown color and a mellow taste. One of the primary aspects of the research is the method of generation of theabrownins, which is mainly through microbial fermentation. This method seemingly enhances the health-promoting qualities of dark tea, especially its hypolipidemic effect, compared to other tea variants. The results of the study affirm the host of health benefits provided by theabrownins - including the modulation of lipid metabolism, reduction in body weight gain, attenuation of diabetes, mitigation of NAFLD, scavenging ROS, and prevention of tumors. Particular attention was given to the role that theabrownins play in influencing the gut microbiota, leading to significant health benefits. Despite some limitations, these factual conclusions advocate the potential of dark tea in fostering human health, premised upon its theabrownins content.

A Animal Study published in 2023 in the journal European Journal of Medicinal Chemistry found that Jin Si Huang Ju tea, a traditional Chinese beverage, contains compounds that potentially reduce lipids, mitigate insulin resistance and reduce liver inflammation in vitro. The researchers identified 14 compounds in the Jinsi Huangju tea using different spectroscopic techniques, 11 of which had not been previously identified in this plant. Two of these compounds, apigenin-7-O-6″-malonylglucoside and luteolin-7-O-6″-malonylglucoside, were synthesized for the first time with a yield of 1.2% over 5 steps. In the findings, the natural compound apigenin-7-O-6″-malonylglucoside was found to inhibit the function of pancreatic lipase, reduce cellular lipid contents, and attenuate insulin resistance when tested in vitro. It was also observed to restore lipid and inflammatory profiles in plasma and the liver, as well as reduce hepatic steatosis in non-alcoholic fatty liver disease (NAFLD) mouse models. Thus, Jinsi Huangju and its active components are strong candidates for the development of drugs or functional foods that could provide a therapeutic strategy for hyperlipidaemia and NAFLD.

A Animal Study published in 2021 in the journal Journal of Integrative Medicine found that Shen Ling Bai Zhu San was found to inhibit inflammatory damage in nonalcoholic fatty liver disease, thus offering potential as a preventive and therapeutic treatment. In the study, rats were put on a high-fat diet, with or without the addition of Shenling Baizhu powder or probiotics. Assessments were made at week 16, using an echo magnetic resonance imaging analyser to examine body composition, a micro-computed tomography imaging system to measure whole body and liver fat, and a laser perfusion imager to study liver microcirculation. After this, the rats were sacrificed and biochemical markers in the blood as well as liver ultrastructure were evaluated. The expression of proteins associated with liver inflammatory signaling pathways were scrutinized via Western blot analysis alongside a high-throughput screening of 29 relevant inflammatory factors in liver tissue. The results indicated that supplementing with Shenling Baizhu powder reduced body weight, serum free fatty acid, and insulin resistance. It also improved liver microcirculation and ultrastructural abnormalities. Quantitative analyses manifested that the treatment lowered fat mass and visceral fat. Moreover, the powder reduced the expression of certain inflammatory signaling pathway-related proteins and modified the expression levels of some inflammatory cytokines found in liver tissues. Thus, indicating that Shenling Baizhu powder could inhibit the activation of inflammatory agents and suppress related expressions, making it potentially beneficial for the prevention and treatment of inflammatory damage and associated diseases.

A Review Article published in 2021 in the journal Chinese Medicine found that With a multi-ingredient and multi-target-pathway pharmacological action, Chinese medicine compounds are compatible with the complex pathogenesis of nonalcoholic fatty liver disease to mitigate it. In the analysis of 88 herbal prescriptions screened out by Ding et al. collected from databases, the top 3 drug combinations are “Hawthorn-Rhizoma Alismatis”, “Rhizoma Alismatis-Radix Salvia Miltiorrhiza” and “Hawthorn-Radix Salvia Miltiorrhiza”, with a high frequency of over 40 in 88 prescriptions. The digestant drug Shan Zha (Hawthorn) mainly improve lipid metabolism and insulin resistance, and protect against oxidative stress in NAFLD. The damp-clearing drug Ze Xie (Rhizoma Alismatis) could alleviate lipidosis as well. Besides, it also has effects on liver regeneration, inflammation and autophagy, which supplement to the effect of Hawthorn. On the other hand, the blood-activating and stasis-eliminating drug Dan Shen (Radix Salvia Miltiorrhiza) have more effects on lipid metabolism, oxidative stress, inflammation, cell death and fibrosis. These are complementary to the effects of Hawthorn and/or Rhizoma Alismatis. As shown in Fig. 3, the combinations of three herbs play a more comprehensive role in treating NAFLD than single herb.

A Systematic Review published in 2021 in the journal Chinese Medicine found that A variety of Chinese herbal medicines have been reported to effectively prevent or treat nonalcoholic fatty liver disease by regulation of the gut microbiota and the gut-liver axis. The key roles of CHMs in the regulation of gut microbiota and the gut-liver axis along with their mechanisms (such as modulating intestinal permeability, reducing the inflammatory response, protecting liver cells, improving lipid metabolism, and modulating nuclear receptors), were well summarized. All the knowledge and information presented here will be very helpful for researchers to better understand the applications and mechanisms of CHMs for treatment of NAFLD.

A Review Article published in 2021 in the journal Pharmacological Research found that Baicalin, a Scutellaria baicalensis extract, has been found to have numerous therapeutic applications in liver and gut diseases by mediating apoptosis and immune response pathways. High-throughput screening and bioinformatics technology were utilized in the extraction and study of baicalin from the dried root of Scutellaria baicalensis Georgi, an herb traditionally used in Chinese medicine. The research sought to understand the biological action of baicalin, particularly how it affects diseases related to the liver and gut. The effects were associated mainly with downstream apoptosis and immune response pathways, which are induced by upstream oxidative stress and inflammation. In the discussion of the resultant findings, it was identified that baicalin engages various key factors during oxidative stress regulation. These include PI3K/Akt/NRF2, Keap-1, NF-κB, and HO-1, contributing to the healing effects of baicalin on non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, ulcerative colitis, and cholestasis. Further, it was discovered that baicalin plays a therapeutic role in regulating inflammatory response and apoptosis pathways. This ability aids in the alleviation of liver diseases and suppression of hepatocellular carcinoma. Baicalin was also found to regulate the intestinal flora by promoting the production of short-chain fatty acids, shedding new light on the full range of baicalin's pharmacological effects.

A Review Article published in 2021 in the journal World Journal of Acupuncture-Moxibustion found that Chinese medicine formulas for nonalcoholic fatty liver disease were superior to antioxidants in alanine aminotransferase normalization. Seven systematic reviews were ultimately included. All systematic reviews were conducted based on randomized controlled trials and published in the last decade. According to the AMSTAR 2 tool, one systematic review was judged as having a moderate confidence level, whereas the other studies were rated as having a low or extremely low level of confidence. The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns. According to the GRADE system, only two outcomes were determined as high quality; namely, TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement, and TCM formulas were superior to antioxidants in alanine aminotransferase normalization. Other outcomes were downgraded to lower levels, mainly because of heterogeneity among studies, not meeting optimal information sample size, and inclusion of excessive numbers of small sample studies. Nevertheless, the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.

A Systematic Review published in 2021 in the journal Chinese Medicine found that Traditional Chinese medicines might have various beneficial effects for non-alcoholic fatty liver disease such as improving TCM syndrome score, liver function, and body lipid profile. A total of 53 RCTs involving 5997 participants with NAFLD were included in this review. Each included RCT tested a different TCMs giving a total of 53 TCMs identified in this study. Based on the evaluation of the RCT results, TCMs might have various beneficial effects such as improving TCM syndrome score, liver function, and body lipid profile. A range of non-serious, reversible adverse effects associated with the use of TCMs were also reported. However, no conclusion about the efficacy and safety of TCMs in NAFLD can be made. The quality of reporting was generally poor and the risks of bias was mostly uncertain in all trials. There is some evidence from RCTs that supported the effectiveness and safety of TCMs for NAFLD. However, no conclusive recommendations can be made due to the questionable quality of the RCTs. Improvement in the RCT protocol, the use of a larger sample size, a setting of multicenter, and a more focused approach in selecting TCMs are recommended for developing high quality evidence about the use of TCMs in managing NAFLD.

A Systematic Review published in 2021 in the journal Chinese Medicine found that Traditional Chinese medicines such as Shenge formula, Shugan Jianpi Huatan decoction and Heze lipid lowing oral liquid decoction might have positive effects on NAFLD by improving TCM syndrome scores, liver function, and body lipid profile. A total of 53 RCTs involving 5997 participants with NAFLD were included in this review. Each included RCT tested a different TCMs giving a total of 53 TCMs identified in this study. Based on the evaluation of the RCT results, TCMs might have various beneficial effects such as improving TCM syndrome score, liver function, and body lipid profile. A range of non-serious, reversible adverse effects associated with the use of TCMs were also reported. However, no conclusion about the efficacy and safety of TCMs in NAFLD can be made. The quality of reporting was generally poor and the risks of bias was mostly uncertain in all trials.

A Review Article published in 2020 in the journal The Journal of Nutritional Biochemistry found that Catechin-rich green tea extract (GTE) exercised anti-inflammatory activities can be beneficial in managing Nonalcoholic fatty liver disease (NAFLD) by reducing liver injury and gut-derived endotoxins. The research is built around the study of the anti-inflammatory properties of catechin-rich green tea extract (GTE). The primary analytical interest is its effects on inflammatory responses that contribute to Nonalcoholic fatty liver disease (NAFLD), specifically nonalcoholic steatohepatitis (NASH). The extraction focuses on inhibiting the activation of the hepatic nuclear factor kappa-B, which is known to exacerbate liver injury. The results have shown positive contributions of GTE to management of NAFLD. Itn was observed that the extract limits the activation of the hepatic nuclear factor kappa-B and in turn, reduces NASH-associated liver injury. Additionally, green tea extract was found to contain hepatic-level benefits that attenuate intracellular redox distress and pro-inflammatory signaling. It was also found to improve the gut barrier function, limit the translocation of gut-derived endotoxins, and exercise prebiotic and antimicrobial effects on the gut microbial ecosystem. These results can potentially contribute to managing NAFLD-associated morbidity.

A Review Article published in 2020 in the journal Frontiers in Endocrinology found that Many clinical and experimental studies suggest that Chinese herbal formula are effective in reducing fatty liver disease, and revolving inflammation via many mechanistic pathways. The NAFLD pandemic implies an increase number of patients diagnosed with NAFL, NASH, liver fibrosis and HCC in the near future. Although the interpretation and diagnosis of NAFLD in Chinese medicine are different from those in western medicine, many clinical and experimental studies suggest that Chinese herbal formula are effective in reducing hepatic steatosis, and revolving inflammation via many mechanistic pathways. Some Chines herbal formulae also target at the gut–liver axis in NAFLD, while the adipose tissue–liver axis emerges to be a therapeutic approach for the treatment of NAFLD. More clinical and in-depth mechanistic investigations may help to validate the roles of these Chinese herbal formulae for the treatment of NAFLD. Application of the modern technology can also help to discover novel herbal-based therapeutics for the treatment.

A Systematic Review published in 2020 in the journal Phytotherapy Research found that Green tea influences liver enzymes differently based on an individual's health status, reducing levels in patients with Nonalcoholic Fatty Liver Disease, but slightly increasing levels in healthy subjects. The researchers initiated a comprehensive review and analysis of randomized clinical trials relating to green tea supplementation's effects on liver enzymes. This analysis included forms of green tea supplementation, such as catechin. The information to support this examination was sourced from four medical and health databases and included all trials examining the influence of green tea or its derivatives on specific liver enzymes, including Alanine Transaminase, Aspartate Aminotransferase, Alkaline Phosphatase, and Bilirubin. Altogether, fifteen trials were considered for inclusion in this research. The study found that while the overall effect of green tea on liver enzymes was nonsignificant, further analysis showed that the impact of green tea on liver enzymes varies depending on an individual's health status. Notably, the use of green tea reduced liver enzyme levels in participants diagnosed with Nonalcoholic Fatty Liver Disease. However, in contrast, a small but statistically significant increase in liver enzyme levels was observed in healthy subjects. These findings suggest that the therapeutic potential of green tea may differ significantly based on an individual's health condition.

A Experimental Study published in 2019 in the journal Nature Communications found that Pu-erh tea was found to lower triglyceride and total cholesterol levels more significantly than green, oolong, or black teas. Comparative studies using rodents treated with Pu-erh tea, green tea, and black tea provided supporting evidence that fully fermented Pu-erh tea is more effective in causing hypolipidemic and hypocholesterolemic effects compared to other partially fermented and non-fermented teas.

A Systematic Review published in 2018 in the journal The Journal of Internal Korean Medicine found that Acupuncture relieved hepatic steatosis and reduced total cholesterol and triglyceride in non-alcoholic fatty liver disease patients. From the 8 included trials, the values of the following examinations were extracted: liver ultrasonography, liver CT, body fat CT, aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyltransferase (GGT), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, fasting blood sugar (FBS), hosmeostatic model assessment for insulin resistance (HOMA-IR), weight, body mass index (BMI), waist hip ratio (WHR), obesity degree, body fat mass, body fat rate, leptin, malondialdehyde (MDA), and super oxide dismutase (SOD). In the 4 outcomes, cure rate in liver ultrasonography (RR=1.56; 95%CI=1.05~2.31; P=0.03), cure rate in liver CT (RR=2.23; 95%CI=1.33~3.72; P=0.002), TC (MD=-0.78; 95%CI=-1.41~-0.15; P=0.02), and TG (MD=-2.05; 95%CI= -3.88~-0.21; P=0.03), acupuncture was more effective than the control intervention.

A Experimental Study published in 2017 in the journal Food & Function found that When combined, Silibinin and Pu-erh tea extract prove more effective in preventing non-alcoholic fatty liver disease than when used individually. The research used obese mice (ob/ob) and fed them a high-fat diet along with the oral administration of Silibinin, Pu-erh tea extract, or both, over a six-week period. Concurrently, lean mice were used as a control group, consuming a regular diet. The blood chemical index and histopathological evaluations were analyzed to determine the effects of Silibinin and Pu-erh tea extract on the mice, particularly in terms of weight, blood lipid levels, fat metabolism, and inflammatory response. The results showcased that in comparison to the group of mice suffering from non-alcoholic fatty liver disease, the groups which received either Pu-erh tea extract, Silibinin, or a combination of both exhibited significant reductions in weight and blood lipid levels. Furthermore, both Silibinin and Pu-erh tea extract, whether used alone or in tandem, were found to improve fat metabolism and decrease the inflammatory response to a certain extent. The combined group, however, displayed the strongest efficacy in adjusting fat metabolism and inhibiting oxidative stress. They also revealed the drugs' ability to inhibit fat synthesis and improve cholesterol homeostasis by regulating the expression of specific genes. The combined effect was superior to that of individual usage.

A Systematic Review published in 2012 in the journal Molecular Biology Reports found that Traditional Chinese medicines had a better effect on the normalization of alanine aminotransferase and disappearance of radiological steatosis in the treatment of non-alcoholic fatty liver disease. RCTs comparing either TCM formulations alone or in combination with placebo, ursodeoxycholic acid, insulin sensitizers, lipid-lowering drugs, or antioxidants were included. The category of most usually used herbs in the treatment of NAFLD was also calculated. Five thousand nine hundred and four patients from 62 RCTs were included for meta-analysis and 25,661 patients from 419 clinical studies were for TCM formulation analysis. Comparing with western medicines mentioned above, TCM had a better effect on the normalization of alanine aminotransferase and disappearance of radiological steatosis in the treatment of NAFLD. Furthermore, 246 kinds of Chinese herbs were included in our present study, with an average of 10 herbs (range 1–31) in each formulation. Hawthorn Fruit (321 times in 17,670 patients) was the most often used herb in the treatment of NAFLD. In conclusion, TCM is of modest benefit to the treatment of NAFLD.

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