The impact of turmeric or its curcumin extract on nonalcoholic fatty liver disease: a systematic review of clinical trials
Background: Turmeric and its curcumin extract have been evaluated in patients with nonalcoholic fatty liver disease (NAFLD), a common ailment that can lead to irreparable liver damage.
Objective: To identify the evidence supporting the use of turmeric or curcumin therapy in NAFLD.
Methods: We searched PubMed, EMBASE, and Cochrane Central from the earliest possible date to 12/17/18 including terms for turmeric, curcumin, and NAFLD. We assessed the impact of turmeric or its curcumin extract on alanine transaminase (ALT), aspartate transaminase (AST), and NAFLD severity via ultrasound.
Results: Five trials assessed the comparative efficacy of curcumin/turmeric in NAFLD. One trial was single armed with comparisons only versus baseline and another trial was only available in abstract form. All of the trials had small sample sizes, 4 of 5 trials had limited durations of follow-up, and all trials had methodological limitations that negatively impacted the strength and applicability of evidence. Clinical and methodological heterogeneity precluded statistical pooling. Three of the 4 trials with evaluable data for turmeric or curcumin versus their own baseline demonstrated significant reductions in ALT, AST, and NAFLD severity grade. Two of the 4 placebo controlled trials had significant mean difference reductions in ALT and AST for turmeric or curcumin versus placebo while 2 of 3 of these trials found significant reductions in NAFLD severity grade. Among these trials, only one used turmeric instead of a curcumin extract and this turmeric trial did not demonstrate any differences in ALT, AST, or NAFLD severity between the turmeric and placebo groups.
Conclusions: Curcumin extract is a promising, but not proven, treatment for NAFLD while the role for turmeric is less clear. The general findings are that ALT, AST and NAFLD severity are reduced with the use of curcumin.
Olatunde S, Boon H, Hirschkorn K, Welsh S, Bajcar J. Roles and responsibilities of pharmacists with respect to natural health products: key informant interviews. Res Social Adm Pharm. 2010;6(1):63-69. https://dx.doi.org/10.1016/j.sapharm.2009.02.004
Gabay M, Smith JA, Chavez ML, Goldwire M, Walker S, Coon SA, Gosser R, Hume AL, Musselman M, Phillips J, Abe AM. White paper on natural products. Pharmacotherapy 2017;37(1):e1–e15) https://dx.doi.org/10.1002/phar.1874
White CM, Sanders Schmidler GD, Butler M, Wang Z, Robinson K, Mitchell MD, Berkman N, Henderson J, Fiordalisi C, Hartling L, Newberry SJ, Guise JM. Understanding health-systems’ use of and need for evidence to inform decisionmaking: research white paper. AHRQ Publication No. 17(18)-EHC035-EF. Rockville, MD: AHRQ; 2017.
Toklu HZ. Promoting evidence-based practice in pharmacies. Integr Pharm Res Pract. 2015;4:127-131. https://dx.doi.org/10.2147/IPRP.S70406
Benedict M, Zhang X. Non-alcoholic fatty liver disease: an expanded review. World J Hepatol 2017;9(16):715-732. https://dx.doi.org/10.4254/wjh.v9.i16.715
Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, Harrison SA, Brunt EM, Sanyal AJ.The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67(1):328-357. https://dx.doi.org/10.1002/hep.29367
Pacana T, Sanyal AJ. Vitamin E and non-alcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care. 2012;15(6):641-648. https://dx.doi.org/10.1097/MCO.0b013e328357f747
Lobo R, Prabhu KS, Shirwaikar A, Shirwaikar A. Curcuma zedoaria Rosc. (white turmeric): a review of its chemical, pharmacological and ethnomedicinal properties. J Pharm Pharmacol 2009;61(1):13-21. https://dx.doi.org/10.1211/jpp/61.01.0003
Chirapongsathorn S. Curcumin trend to improve alanine transaminase (ALT) in nonalcoholic fatty liver disease (NAFLD) with abnormal ALT. Asian Pacific Digestive Week, Bangkok, Thailand 2012. Available at: https://www.researchgate.net/publication/275333690_Curcumin_trend_to_improve_alanine_transaminase_ALT_in_non-alcoholic_fatty_liver_disease_NAFLD_with_abnormal_ALT (accessed Dec 17, 2018).
Wei Z, Liu N, Tantai X, Xing X, Xiao C, Chen L, Wang J. The effects of curcumin on the metabolic parameters of nonalcoholic fatty liver disease: a meta-analysis of randomized controlled trials. Hepatol Int 2018 [Epub ahead of print]. https://dx.doi.org/10.1007/s12072-018-9910-x
Panahi Y, Kianpour P, Mohtashami R, Soflaei SS, Sahebkar A.Efficacy of phospholipidated curcumin in nonalcoholic fatty liver disease: a clinical study. J Asian Nat Prod Res 2018 [Epub ahead of print]. https://dx.doi.org/10.1080/10286020.2018.1505873
Panahi Y, Kianpour P, Mohtashami R, Jafari R, Simental-Mendía LE, Sahebkar A. Efficacy and safety of phytosomal curcumin in non-alcoholic fatty liver disease: a randomized controlled trial. Drug Res 2017;67(4):244-251. https://dx.doi.org/10.1055/s-0043-100019
Rahmani S, Asgary S, Askari G, Keshvari M, Hatamipour M, Feizi A, Sahebkar A. Treatment of non-alcoholic fatty liver disease with curcumin: a randomized placebo-controlled trial. Phytother Res 2016;30(9):1540-1548. https://dx.doi.org/10.1002/ptr.5659
Navekar R, Rafraf M, Ghaffari A, Asghari-Jafarabadi M, Khoshbaten M. Turmeric supplementation improves serum glucose indices and leptin levels in patients with nonalcoholic fatty liver diseases. J Am Coll Nutr 2017;36(4):261-267. https://dx.doi.org/10.1080/07315724.2016.1267597
Jazayeri-Tehrani SA, Rezayat SM, Mansouri S, Qorbani M, Alavian SM, Daneshi-Maskooni M, Hosseinzadeh-Attar MJ. Efficacy of nanocurcumin supplementation on insulin resistance, lipids, inflammatory factors and nesfatin among obese patients with non-alcoholic fatty liver disease (NAFLD): a trial protocol. BMJ Open. 2017;7(7):e016914. https://dx.doi.org/10.1136/bmjopen-2017-016914
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.