Pharmacological Research (Mar 2023)
Nutraceutical approaches to non-alcoholic fatty liver disease (NAFLD): A position paper from the International Lipid Expert Panel (ILEP)
- Manfredi Rizzo,
- Alessandro Colletti,
- Peter E. Penson,
- Niki Katsiki,
- Dimitri P. Mikhailidis,
- Peter P. Toth,
- Ioanna Gouni-Berthold,
- John Mancini,
- David Marais,
- Patrick Moriarty,
- Massimiliano Ruscica,
- Amirhossein Sahebkar,
- Dragos Vinereanu,
- Arrigo Francesco Giuseppe Cicero,
- Maciej Banach,
- Julio Acosta,
- Mutaz Al-Khnifsawi,
- Fahad Alnouri,
- Fahma Amar,
- Atanas G. Atanasov,
- Gani Bajraktari,
- Maciej Banach,
- Ioanna Gouni-Berthold,
- Sonu Bhaskar,
- Agata Bielecka-Dąbrowa,
- Bojko Bjelakovic,
- Eric Bruckert,
- Ibadete Bytyçi,
- Alberto Cafferata,
- Richard Ceska,
- Arrigo F.G. Cicero,
- Krzysztof Chlebus,
- Xavier Collet,
- Magdalena Daccord,
- Olivier Descamps,
- Dragan Djuric,
- Ronen Durst,
- Marat V. Ezhov,
- Zlatko Fras,
- Dan Gaita,
- Ioanna Gouni-Berthold,
- Adrian V. Hernandez,
- Steven R. Jones,
- Jacek Jozwiak,
- Nona Kakauridze,
- Amani Kallel,
- Niki Katsiki,
- Amit Khera,
- Karam Kostner,
- Raimondas Kubilius,
- Gustavs Latkovskis,
- G.B. John Mancini,
- A. David Marais,
- Seth S. Martin,
- Julio Acosta Martinez,
- Mohsen Mazidi,
- Dimitri P. Mikhailidis,
- Erkin Mirrakhimov,
- Andre R. Miserez,
- Olena Mitchenko,
- Natalya P. Mitkovskaya,
- Patrick M. Moriarty,
- Seyed Mohammad Nabavi,
- Devaki Nair,
- Demosthenes B. Panagiotakos,
- György Paragh,
- Daniel Pella,
- Peter E. Penson,
- Zaneta Petrulioniene,
- Matteo Pirro,
- Arman Postadzhiyan,
- Raman Puri,
- Ashraf Reda,
- Željko Reiner,
- Dina Radenkovic,
- Michał Rakowski,
- Jemaa Riadh,
- Dimitri Richter,
- Manfredi Rizzo,
- Massimiliano Ruscica,
- Amirhossein Sahebkar,
- Maria-Corina Serban,
- Abdullah M.A Shehab,
- Aleksandr B. Shek,
- Cesare R. Sirtori,
- Claudia Stefanutti,
- Tomasz Tomasik,
- Peter P. Toth,
- Margus Viigimaa,
- Pedro Valdivielso,
- Dragos Vinereanu,
- Branislav Vohnout,
- Stephan von Haehling,
- Michal Vrablik,
- Nathan D. Wong,
- Hung-I Yeh,
- Jiang Zhisheng,
- Andreas Zirlik
Affiliations
- Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Via del Vespro 141, 90127 Palermo, Italy; Corresponding author.
- Alessandro Colletti
- Department of Science and Drug Technology, University of Turin, Turin, Italy
- Peter E. Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK
- Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece; School of Medicine, European University Cyprus, Nicosia, Cyprus
- Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, Medical School, University College London (UCL), London, UK
- Peter P. Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
- Ioanna Gouni-Berthold
- Department of Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
- John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
- Patrick Moriarty
- Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Dragos Vinereanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular disease risk research center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy; IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
- Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland; Correspondence to: Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland.
- Julio Acosta
- Cátedra de Cardiología Clínica de la Escuela Médica Razetti de la Universidad Central de Venezuela, Caracas, Venezuela
- Mutaz Al-Khnifsawi
- Al-Qadisiyah University, Faculty of Medicine, Department of Internal Medicine, Diwaniya City, Iraq
- Fahad Alnouri
- Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
- Fahma Amar
- Unit of Diabetes & Metabolism, Alexandria University, Alexandria, Egypt
- Atanas G. Atanasov
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland; Department of Pharmacognosy, University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo, Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland; Cardiovascular Research Centre, University of Zielona-Gora, Zielona-Gora, Poland
- Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
- Sonu Bhaskar
- Department of Neurology & Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia
- Agata Bielecka-Dąbrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Bojko Bjelakovic
- Clinic of Pediatrics, Clinical Center, Nis, Faculty of Medicine, University of Nis, Serbia
- Eric Bruckert
- Pitié-Salpetrière Hospital and Sorbonne University, Cardio metabolic Institute, Paris, France
- Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden & Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- Alberto Cafferata
- Council of Epidemiology and Cardiovascular Prevention ''Dr. Mario Ciruzzi'', Argentine Society of Cardiology, Buenos Aires, Argentina
- Richard Ceska
- Third Department of Medicine - Department of Endocrinology and Metabolism of the First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Arrigo F.G. Cicero
- IRCCS Policlinico S.Orsola-Malpighi, University of Bologna, Italy
- Krzysztof Chlebus
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
- Xavier Collet
- Institute of Metabolic and Cardiovascular Diseases, Inserm, Toulouse, France
- Magdalena Daccord
- FH Europe, France
- Olivier Descamps
- Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine Saint-Paul, Belgium; Department of Cardiology, Cliniques Universitaires Saint-Luc, Bruxells, Belgium
- Dragan Djuric
- Institute of Medical Physiology ''Richard Burian'' Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Ronen Durst
- Cardiology Department, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
- Marat V. Ezhov
- National Medical Research Center of Cardiology, Moscow, Russia
- Zlatko Fras
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Dan Gaita
- Institutul de Boli Cardiovasculare, Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Romania
- Ioanna Gouni-Berthold
- Department of Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
- Adrian V. Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA; Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru
- Steven R. Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
- Jacek Jozwiak
- Department of Family Medicine and Public Health Faculty of Medicine University of Opole, Opole, Poland
- Nona Kakauridze
- Department of Internal Medicine, Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia
- Amani Kallel
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
- Niki Katsiki
- Diabetes Center, Division of Endocrinology and Metabolism, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Amit Khera
- Department of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
- Karam Kostner
- Mater Hospital, University of Queensland, St Lucia, QLD, Australia
- Raimondas Kubilius
- Department of Rehabilitation, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Gustavs Latkovskis
- Institute of Cardiology and Regenerative Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia; Pauls Stradins Clinical University Hospital, Riga, Latvia
- G.B. John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- A. David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
- Seth S. Martin
- Ciccarone Center for Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Julio Acosta Martinez
- Medico Cardiologo de la Policlinica Metropolitana, Carcass, Venezuela
- Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Strand, London, UK
- Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
- Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Andre R. Miserez
- diagene Research Institute, Reinach, Switzerland; University of Basel, Basel, Switzerland
- Olena Mitchenko
- Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Ukraine
- Natalya P. Mitkovskaya
- Belarusian State Medical Univer- sity, Minsk, Republic of Belarus
- Patrick M. Moriarty
- Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Devaki Nair
- Department of Clinical Biochemistry, the Royal Free London NHS Foundation Trust, Pond Street, London, UK
- Demosthenes B. Panagiotakos
- School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
- György Paragh
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Daniel Pella
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia
- Peter E. Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
- Zaneta Petrulioniene
- Vilnius University Faculty of Medicine, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Matteo Pirro
- Department of Medicine, University of Perugia, Perugia, Italy
- Arman Postadzhiyan
- Bulgarian Society of Cardiology, Medical University of Sofia, Sofia, Bulgaria
- Raman Puri
- I P Apollo Hospital, New Delhi, India
- Ashraf Reda
- Menoufia University, President of EAVA, Egypt
- Željko Reiner
- University Hospital Center Zagreb, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
- Dina Radenkovic
- Health Longevity Performance Optimisation Institute, Cambridge, UK
- Michał Rakowski
- International Lipid Expert Panel, Poland; The Bio-Med-Chem Doctoral School of the University of Lodz and Lodz Institutes of the Polish Academy of Sciences / University of Lodz, Faculty of Biology and Environmental Protection, Department of Molecular Biophysics, University of Lodz, Lodz, Poland
- Jemaa Riadh
- Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
- Dimitri Richter
- Cardiac Department, Euroclinic, Athens, Greece
- Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
- Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Maria-Corina Serban
- Department of Functional Sciences, Discipline of Pathophysiology, ''Victor Babes'' University of Medicine and Pharmacy, Timisoara, Romania
- Abdullah M.A Shehab
- Medical Education Department, United Arab Emirates University, Al Ain, United Arab Emirates
- Aleksandr B. Shek
- Department of Ischemic Heart Disease and Atherosclerosis, Republican Specialised Center of Cardiology, Tashkent, Uzbekistan
- Cesare R. Sirtori
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano Centro Dislipidemie, Grande Ospedale Metropolitano, Niguarda Ca'Granda President, Fondazione Carlo Sirtori, Italy
- Claudia Stefanutti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Tomasz Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
- Peter P. Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
- Margus Viigimaa
- Tallinn University of Technology, North Estonia Medical Centre, Tallinn, Estonia
- Pedro Valdivielso
- Catedrático de Medicina, Departamento de Medicina y Dermatología, Universidad de Málaga, España
- Dragos Vinereanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Branislav Vohnout
- Institute of Nutrition, Faculty of Nursing and Health Professional Studies and Coordination Centre for Familial Hyperlipoproteinemias, Slovak Medical University in Bratislava, Bratislava, Slovakia; Institute of Epidemiology, School of Medicine, Comenius University, Bratislava, Slovakia
- Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center, Georg-August-University, Göttingen, Germany
- Michal Vrablik
- 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Nathan D. Wong
- Department of Medicine, School of Medicine University of California, Irvine, CA, USA; Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, USA
- Hung-I Yeh
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Jiang Zhisheng
- Institute of Cardiovascular Disease, University of South China, Hengyang, Hunan, China
- Andreas Zirlik
- University Heart Centre Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Journal volume & issue
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Vol. 189
p. 106679
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10–25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease.The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.
