L-Carnitine Supplementation to Diet: A New Tool in Treatment of Nonalcoholic Steatohepatitis—A Randomized and Controlled Clinical Trial

Malaguarnera, Mariano; Gargante, Maria Pia; Russo, Cristina; Antic, Tijana; Vacante, Marco; Malaguarnera, Michele; Avitabile, Teresio; Volti, Giovanni Li; Galvano, Fabio

doi:10.1038/ajg.2009.719

Cited by 200 publications

(193 citation statements)

References 46 publications

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“…Future trials need to assess, in particular, whether implementing effective weigh-loss regimens with drugs has synergistic benefits on liver histology. 56,63 With the exception of telmisartan, 61 available treatments show no consistent benefit on hepatic fibrosis; this may be attributable to an actual ineffectiveness of proposed treatments, to a short trial duration, or to the inclusion of subjects with mild degrees of fibrosis. Longer follow-up will tell whether improvement of inflammatory changes may favorably affect clinical outcomes, because inflammation at initial biopsy independently predicted fibrosis progression in NASH over 5 years.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease

Musso¹,

Gambino²,

Cassader³

et al. 2010

Hepatology

507

426

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Nonalcoholic fatty liver disease (NAFLD) encompasses a histological spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). NAFLD carries a higher risk of cardio-metabolic and liver-related complications, the latter being confined to NASH and demanding specific treatment. We assessed the efficacy of proposed treatments for NAFLD/NASH by reviewing reports of randomized controlled trials (RCTs) on online databases and national and international meeting abstracts through January 2010. Primary outcome measure was histological improvement; secondary outcome was biochemical improvement; improvement in radiological steatosis was also evaluated. Two reviewers extracted articles using predefined quality indicators, independently and in duplicate. Main outcomes of randomized controlled trials (RCTs) were pooled using random-effects or fixed-effects models. Publication bias was assessed by funnel plots. Forty-nine RCTs (30 in NASH) were included: 23 RCTs (22 in NASH, 1 in NAFLD) had post-treatment histology. Most RCTs were small and did not exceed 1-year duration. Weight loss, thiazolidinediones (especially pioglitazone), and antioxidants were most extensively evaluated. Weight loss was safe and dose-dependently improved histological disease activity in NASH, but more than 50% of patients failed to achieve target weight loss. Thiazolidinediones improved steatosis and inflammation but yielded significant weight gain. RCTs with antioxidants yielded conflicting results and were heterogeneous with respect to type and dose of drug, duration, implementation of lifestyle intervention. Among the other agents, pentoxifylline, telmisartan and L-carnitine improved liver histology in at least 1 RCT in NASH; polyunsaturated fatty acid (PUFA) ameliorated biochemical and radiological markers of NAFLD. Other approaches yielded negative results. Conclusion: Well-designed RCTs of adequate size and duration, with histological endpoints, are needed to assess long-term safety and efficacy of proposed treatments on patient-oriented clinical outcomes. (HEPATOLOGY 2010;52:79-104)

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Section: Discussionmentioning

confidence: 99%

A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease

Musso¹,

Gambino²,

Cassader³

et al. 2010

Hepatology

507

426

View full text Add to dashboard Cite

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“…Gut bacteria may promote liver injury and systemic inflammation through endotoxin-mediated toll-like receptor-4 axis activation and other mechanisms, predisposing to NASH, diabetes and atherosclerosis [102]. Three RCTs assessed probiotics in NAFLD: the first, evaluating VSL3, was prematurely terminated for an increase in hepatic steatosis [103]; the others, assessing a mixture of Lactobacillus spp.…”

Section: %) (G) Homa Index Change (%) (H) Fpg Change (%) (I) Serummentioning

confidence: 99%

Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials

et al. 2012

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Aims/hypothesis Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum ranging from simple steatosis to non-alcoholic steatohepatitis (NASH): NAFLD causes an increased risk of cardiovascular disease, diabetes and liverrelated complications (the latter confined to NASH). The effect of proposed treatments on liver disease, glucose metabolism and cardiovascular risk in NAFLD is unknown. We reviewed the evidence for the management of liver disease and cardiometabolic risk in NAFLD. Methods Publications through November 2011 were systematically reviewed by two authors. Outcomes evaluated though standard methods were: histological/radiological/biochemical features of NAFLD, variables of glucose metabolism and cardiovascular risk factors. Seventy-eight randomised trials were included (38 in NASH, 40 in NAFLD): 41% assessed post-treatment histology, 71% assessed glucose metabolism and 88% assessed cardiovascular risk factors. Lifestyle intervention, thiazolidinediones, metformin and antioxidants were most extensively evaluated. Results Lifestyle-induced weight loss was safe and improved cardio-metabolic risk profile; a weight loss ≥7% improved histological disease activity, but was achieved by <50%

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“…Malaguarnera et al [107] showed that the addition of an L-carnitine supplement to an individual's diet for 24 wk, reduced TNF-α and CRP, and improved liver function, plasma glucose levels, lipid profile, HOMA IR, and histological manifestations of NASH [107] ; how long these effects will sustain was not evaluated.…”

Section: Carnitinmentioning

confidence: 99%

Recent advances in dietary supplementation, in treating non-alcoholic fatty liver disease

Eslamparast¹,

Eghtesad²,

Poustchi³

et al. 2014

WJH

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L-Carnitine Supplementation to Diet: A New Tool in Treatment of Nonalcoholic Steatohepatitis—A Randomized and Controlled Clinical Trial

Abstract: L-carnitine supplementation to diet is useful for reducing TNF-alpha and CRP, and for improving liver function, glucose plasma level, lipid profile, HOMA-IR, and histological manifestations of NASH.

Cited by 200 publications

References 46 publications

A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease

A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease

Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials

Recent advances in dietary supplementation, in treating non-alcoholic fatty liver disease

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