Hepat Mon.2012;12(8):e6099. DOI: 10.5812/hepatmon.6099 KOWSAR www.HepatMon.com Effects of Metformin, Pioglitazone, and Silymarin Treatment on Non- Alcoholic Fatty Liver Disease: A Randomized Controlled Pilot Study Ali Akbar Hajiaghamohammadi 1, Amir Ziaee 1, Sonia Oveisi 1*, Homa Masroor 1 1 Metabolic Disease Research Center, Qazvin University of Medical Science, Qazvin, IR Iran A R T I C L E I N F O Article type: Original Article Article history: Received: 12 May 2012 Revised: 30 May 2012 Accepted: 11 Jul 2012 Keywords: Metformin Pioglitazone Silymarin Cardiovascular System Non-Alcoholic Fatty Liver Disease A B S T R A C T Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common rea- sons of enzyme increase in liver. In About 10 percent of patients with NAFLD, the disease progresses toward Non Alcoholic Steatohepatitis (NASH) and about one third of them may progress toward cirrhosis, liver dysfunction, and even hepatocellular carcinoma. Objectives: According to high prevalence of NAFLD and the fact that there is no consen- sus on treatment of this disease, the aim of this study was to assess the effects of met- formin, pioglitazone, and silymarin on treatment of NAFLD. Patients and Methods: Sixty six patients with NAFLD who were presented in the Endocri- nology and Metabolism clinic of Boo’ali Hospital, Qazvin, Iran, were assigned randomly into three groups (n = 22). First group was treated by pioglitazone 15 mg/d, second group by metformin 500 mg/d, and third group by silymarin 140 mg/d. All patients underwent clinical and biochemical evaluations including weight, fasting blood sugar (FBS), lipid profiles, body mass index (BMI), aspartate aminotransferase (AST ), alanine aminotrans- ferase (ALT), and serum insulin levels in pre- and post-intervention after eight-week fol- low up. Results: Before the treatment there was no significant difference between three groups with respect to average age, BMI and gender, FBS, lipid profile, AST, ALT, serum insulin level, and Homeostasis Model Assessment (HOMA) index for insulin resistance. After the intervention, a significant reduction was observed in average amount of FBS, lipid profile, ALT, AST, serum insulin level and HOMA index in three groups (P < 0.01). The most reduction in average FBS, TG, serum insulin level, and HOMA index was observed in pioglitazone group, the most reduction in average amount of cholesterol was seen in metformin group, and the most decrease in average amount of AST and ALT occurred in silymarin group. Conclusions: These results suggest that all drugs are beneficial in improving biochemi- cal indices in patients with NAFLD. Changes in AST and ALT in silymarin group were dem- onstrated more than that in other groups and the average difference between changes was significant between silymarin and metformin groups. Published by Kowsar Corp, 2012. cc 3.0. Implication for health policy/practice/research/medical education: From our research, there are some implications to treat the fatty liver patients for concerning of internal physician in the practice. Please cite this paper as: Hajiaghamohammadi AA, Ziaee A, Oveisi S, Masroor H. Effect of Metformin, Pioglitazone and Silymarin Treatment in Non Alcoholic Fatty Liver Disease: A Randomized Controlled Pilot Study. Hepat Mon. 2012;12(8): e6099. DOI: 10.5812/hepatmon.6099 * Corresponding author: Sonia Oveisi, Metabolic Disease Research Center, Qazvin University of Medical Science, Boo’ali Hospital, Boali St., Qazvin, IR Iran. Tel: +98-2813360084, Fax: +98-2813326033, E-mail: soveisi@razi.tums.ac.ir DOI: 10.5812/hepatmon.6099 © 2012 Baqiyatallah Research Center for Gastroentrology and liver diseases; Published by Kowsar Corp. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which per- mits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.