Impact of combined therapy with alpha-lipoic and ursodeoxycolic acid on nonalcoholic fatty liver disease: double-blind, randomized clinical trial of efficacy and safety Omega-3 Fatty acids therapy in children with nonalcoholic Fatty liver disease: a randomized controlled trial. Effects of Metformin, Pioglitazone, and Silymarin Treatment on Non-Alcoholic Fatty Liver Disease: A Randomized Controlled Pilot Study A randomized double-blind study of the short-time treatment of obese patients with nonalcoholic fatty liver disease with ursodeoxycholic acid. Protective role of carnitine ester against radiation-induced oxidative stress in rats. Treatment of non-alcoholic fatty liver disease with metformin versus lifestyle intervention in insulin-resistant adolescents. Cholic acid for hepatic steatosis in patients with lipodystrophy: a randomized, controlled trial. Cinnamon may have therapeutic benefits on lipid profile, liver enzymes, insulin resistance, and high-sensitivity C-reactive protein in nonalcoholic fatty liver disease patients. Management of fatty liver disease with vitamin E and C compared to ursodeoxycholic acid treatment. Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a pilot study. Effect of a Probiotic and Metformin on Liver Aminotransferases in Non-alcoholic Steatohepatitis: A Double Blind Randomized Clinical Trial A randomized trial of iron depletion in patients with nonalcoholic fatty liver disease and hyperferritinemia. Activity of liver enzymes in multiple sclerosis patients with Hot-nature diet and co-supplemented hemp seed, evening primrose oils intervention. l-Carnitine Supplementation to Diet: A New Tool in Treatment of Nonalcoholic Steatohepatitis—A Randomized and Controlled Clinical Trial Randomized controlled trial for an effect of catechin-enriched green tea consumption on adiponectin and cardiovascular disease risk factors Effects of lifestyle changes including specific dietary intervention and physical activity in the management of patients with chronic hepatitis C – a randomized trial [Effect of relieving blood stasis, strengthening spleen and soothing liver therapy in improving hepatic function in patients after liver-carcinomectomy]. Silymarin in treatment of non-alcoholic steatohepatitis: A randomized clinical trial. Liver enzymes as a predictor for incident diabetes in a Japanese population: the Hisayama study. Luseogliflozin, A Sodium Glucose Co-transporter 2 Inhibitor, Alleviates Hepatic Impairment in Japanese Patients with Type 2 Diabetes. Gamma-glutamyltransferase, aspartate and alanine aminotransferases and their ratio, mean cell volume and urinary dolichol in pregnant alcohol abusers. An evaluation of hepatic enzyme elevations among HIV-infected released prisoners enrolled in two randomized placebo-controlled trials of extended release naltrexone. Effects of silybum marianum on patients with chronic hepatitis C
Background and purpose Nonalcoholic fatty liver disease ( NAFLD ) is one of the causes of a fatty liver , occurring when fat is deposited ( steatosis ) in the liver not due to excessive alcohol use . It is related to insulin resistance and the metabolic syndrome . The purpose of the present study was to evaluate the impact of combination therapy with alpha-lipoic acid ( ALA ) and ursodeoxycholic acid ( UDCA ) on NAFLD . Methods Alpha-lipoic acid 400 mg/day plus UDCA 300 mg/day ( ALAUDCA ) was investigated in patients over a period of 12 months using a r and omized , placebo (PLA)-controlled study with four parallel groups . Serum concentration of gamma-glutamyl transpeptidase ( GGT ) , alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , albumin and platelets ( PLT ) were measured at the beginning and at the end of the treatment . Moreover , the AST/ALT ratio and the NAFLD fibrosis score were examined . Results A total of 120 patients were r and omly assigned to the four groups . ALA and UDCA were safe and well tolerated in the oral daily administration only . AST , ALT , GGT ( p < 0.001 ) showed a significant difference between ALAUDCA and other three groups . Besides , NAFLD fibrosis score underlined a significant reduction ( p < 0.04 ) in the ALAUDCA group , while AST/ALT ratio presented a moderate decline ( p > 0.05 ) . Conclusion ALAUDCA therapy reduced AST , ALT , GGT values and improved NAFLD fibrosis score and AST/ALT ratio , especially in patients who were on a hypocaloric diet . These findings will be useful in patient selection in future clinical trials with ALAUDCA in long-term studies OBJECTIVE To evaluate the efficacy and safety of omega-3 fatty acid supplementation in children with nonalcoholic fatty liver disease ( NAFLD ) . STUDY DESIGN Overweight/obese children with NAFLD ( n = 76 ; median age , 13 years ; IQR , 11.1 - 15.2 years ) were eligible to participate in the study . The diagnosis of NAFLD was based on elevated alanine aminotransferase ( ALT ) to ≥ 30 % of the upper limit of normal ( ULN ) and liver hyperechogenicity on ultrasound . Patients were r and omized to receive omega-3 fatty acids ( docosahexaenoic acid and eicosapentaenoic acid , 450 - 1300 mg/day ) or placebo ( omega-6 sunflower oil ) . The primary outcome was the number of patients who demonstrated decreased ALT activity by ≥ 0.3 times the ULN . Secondary outcomes included alterations in liver function tests , liver hyperechogenicity , insulin resistance , and other metabolic markers after 6 months of intervention . RESULTS Out of 76 enrolled patients , 64 completed the trial and were analyzed . After 6 months , we found no significant differences between the omega-3 and placebo groups in the number of patients with decreased ALT by ≥ 0.3 times the ULN ( 24 vs 23 ) or in median ( IQR ) ALT activity ( 48.5 [ 31 - 62 ] U/L vs 39 [ 27 - 55 ] U/L ) , liver hyperechogenicity , insulin resistance , or serum lipid levels . However , patients in the omega-3 group had lower levels of aspartate aminotransferase ( 28 [ 25 - 36 ] U/L vs 39 [ 27 - 55 ] U/L ; P = .04 ) and gamma-glutamyl transpeptidase ( 26 [ 17.5 - 36.5 ] U/L vs 35 [ 22 - 52 ] U/L ; P = .04 ) , and significantly higher levels of adiponectin . CONCLUSION Omega-3 fatty acid supplementation did not increase the number of patients with decreased ALT levels and it did not affect liver steatosis on ultrasound , but it improved aspartate aminotransferase and gamma-glutamyl transpeptidase levels in children with NAFLD compared with placebo . TRIAL REGISTRATION Registered with Clinical Trials.gov : NCT01547910 Background Nonalcoholic fatty liver disease ( NAFLD ) is one of the most common reasons 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 consensus on treatment of this disease , the aim of this study was to assess the effects of metformin , pioglitazone , and silymarin on treatment of NAFLD . Patients and Methods Sixty six patients with NAFLD who were presented in the Endocrinology and Metabolism clinic of Boo’ali Hospital , Qazvin , Iran , were assigned r and omly 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 aminotransferase ( ALT ) , and serum insulin levels in pre- and post-intervention after eight-week follow 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 biochemical indices in patients with NAFLD . Changes in AST and ALT in silymarin group were demonstrated more than that in other groups and the average difference between changes was significant between silymarin and metformin groups In order to determine the effect of ursodeoxycholic acid on nonalcoholic fatty liver disease , 30 patients with body mass indices higher than 25 , serum levels of alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) or gamma-glutamyltransferase ( gamma-GT ) at least more than 1.5 times the upper limit of normality , and hepatic steatosis demonstrated by ultrasonography were r and omized into two groups of 15 patients to receive placebo or 10 mg kg-1 day-1 ursodeoxycholic acid for three months . Abdominal computed tomography was performed to quantify hepatic fat content , which was significantly correlated with histological grading of steatosis ( r s = -0.83 , P < 0.01 ) . Patient body mass index remained stable for both groups throughout the study , but a significant reduction in mean ( + /- SEM ) serum levels of ALT , AST and gamma-GT was observed only in the treated group ( ALT = 81.2 + /- 9.7 , 44.8 + /- 7.7 , 48.1 + /- 7.7 and 52.2 + /- 6.3 IU/l at the beginning and after the first , second and third months , respectively , N = 14 , P < 0.05 ) . For the placebo group ALT values were 66.4 + /- 9.8 , 54.5 + /- 7 , 60 + /- 7.6 and 43.7 5 IU/l , respectively . No alterations in hepatic lipid content were observed in these patients by computed tomography examination ( 50.2 + /- 4.2 Hounsfield units ( HU ) at the beginning versus 51.1 + /- 4.1 HU at the third month ) . These results show that ursodeoxycholic acid is able to reduce serum levels of hepatic enzymes in patients with nonalcoholic fatty liver disease , but this effect is not related to modifications in liver fat content The aim of this study was to investigate the antioxidant effect of acetyl-L-carnitine ( ALC ) against gamma-irradiation-induced oxidative damage in liver and lung tissue after total body irradiation with a single dose of 6Gy . To achieve the ultimate goal of this study , 40 adult rats were r and omly divided into 4 groups of 10 animals each . Group I was injected intraperitoneally with saline solution for 5 consecutive days and served as control group . Group II was irradiated with a single dose of 6Gy . Group III was daily injected with ALC ( 250 mg kg(-1 ) , i.p . ) for 5 consecutive days . Group IV received a daily i.p . injection of ALC ( 250 mg kg(-1 ) , i.p . ) for 5 consecutive days and 1h after the last dose , rats were irradiated with a single dose ( 6Gy ) . The animals were sacrified after 24h . Administration of ALC for 5 consecutive days result ed in a significant increase in the activities of both superoxide dismutase ( SOD ) and glutathione peroxidase ( GSHPx ) and the level of reduced glutathione ( GSH ) , in lung and liver tissues which were reduced by radiation treatment . Also , ALC result ed in a significant decrease in total nitrate/nitrite ( NO(x ) ) and malondialdehyde ( MDA ) levels in both lung and liver tissues and a significant decrease in triglycerides , low-density lipoprotein-cholesterol ( LDL ) , high-density lipoprotein-cholesterol ( HDL ) , total cholesterol , Serum alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) levels and Gamma glutamyl transpeptidase ( GGTP ) compared to irradiated group . In conclusion , data obtained from this study indicate that ALC could increase the endogenous antioxidant defense mechanism in rat and there by protect the animals from radiation-induced organs toxicity The presence of fatty liver per ultrasound and liver-associated enzymes were measured in a select cohort of youth with both obesity and insulin resistance , and the effect of metformin on these parameters evaluated . Fifty obese , multiethnic , insulin-resistant adolescents ( mean age 15.1 yr , mean body mass index 39.8 kg/m2 ) were r and omized to receive lifestyle recommendations plus either twice per day doses of 850 mg of metformin or placebo .  Fasting and post-glucose challenge biochemistries and liver ultrasounds were compared at baseline and 6 months . The prevalence of fatty liver was 74 % , elevated alanine aminotransferase ( ALT ) 14 % , aspartate aminotransferase ( AST ) 14 % , and gamma-glutamyl transferase ( GGT ) 17 % . Fatty liver was mild in 23 % , moderate in 31 % , and severe in 46 % . Fatty liver was more common in male and Hispanic subjects and elevated ALT more common in Hispanic subjects . Subjects with fatty liver appeared more insulin resistant ( higher fasting insulin and triglycerides , lower high-density lipoprotein cholesterol ) and had higher ALT and AST . At 6 months , mean ALT , GGT , and fasting insulin improved significantly in all subjects . Fatty liver prevalence ( p < 0.04 ) , severity ( p < 0.04 ) , and fasting insulin ( p < 0.025 ) improved significantly with metformin compared to placebo . Non-alcoholic fatty liver disease ( NAFLD ) occurs with a high prevalence and severity in obese , insulin-resistant adolescents . While metformin plus lifestyle intervention appears promising , defining NAFLD therapies capable of preventing fibrosis and cirrhosis requires further study OBJECTIVE Hepatic steatosis is a common complication in patients with lipodystrophies and can lead to cirrhosis . There is no proven effective therapy for hepatic steatosis , but cholic acid ( CA ) , a farnesoid X receptor agonist , has previously been shown to reduce hepatic triglyceride ( TG ) content in mice and serum TG in humans . Our objective was to assess clinical efficacy and tolerability of CA therapy in patients with lipodystrophy and hepatic steatosis . DESIGN A r and omized , double-blind , placebo-controlled , crossover study . METHODS Eighteen patients with genetic or autoimmune lipodystrophies and elevated hepatic TG content participated in the study . The intervention was CA ( 15 mg/kg per day ) compared with placebo for a period of 6 months each . Hepatic TG content , the primary outcome variable , was measured with (1)H magnetic resonance spectroscopy at baseline and at 3 and 6 months during each study period . Levels of serum alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , gamma-glutamyl transpeptidase ( GGT ) , and TG were secondary end points of the study . RESULTS Compared with placebo , CA did not reduce ( median ( interquartile range ) hepatic TG content ( 14.8 % ( 9.4 - 19.0 % ) vs 15.9 % ( 10.5 - 26.5 % ) respectively ; P=0.42 ) or serum TG ( ( 340 mg/dl ( 233 - 433 mg/dl ) vs 390 mg/dl ( 233 - 595 mg/dl ) respectively ; P=0.45 ) ) . CA therapy also did not change AST , ALT , or GGT levels . Two patients developed diarrhea and excessive flatus while taking CA and these symptoms resolved after reducing the dose of CA . CONCLUSION CA was well tolerated but did not reduce hepatic TG content in patients with lipodystrophy Nonalcoholic fatty liver disease ( NAFLD ) is the most prevalent cause of hepatic injury in the world . One of the most important therapeutic strategies for this disease is modulating insulin resistance and oxidative stress . In this study , we investigated the hypothesis that supplementation with cinnamon exerts an insulin sensitizer effect in patients with NAFLD . In a double-blind , placebo-controlled trial with two parallel groups , fifty patients with NAFLD were r and omized to receive daily supplementation with either two capsules of cinnamon ( each capsule contain 750 mg cinnamon ) or 2 placebo capsules , daily for 12 weeks . During the intervention , all patients were given advice on how to implement a balanced diet and physical activity into their daily lives . In the treatment group ( P < .05 ) , significant decreases in HOMA ( Homeostatic Model Assessment ) index , FBS ( fasting blood glucose ) , total cholesterol , triglyceride , ALT ( alanine aminotransferase ) , AST ( aspartate aminotransferase ) , GGT ( gamma glutamine transpeptidase ) , and high-sensitivity C-reactive protein were seen , but there was no significant change in serum high-density lipoproteins levels ( P = .122 ) . In both groups , low-density lipoproteins decreased significantly ( P < .05 ) . In conclusion , the study suggests that taking 1500 mg cinnamon daily may be effective in improving NAFLD characteristics BACKGROUND / AIMS Despite a proposed role of oxidative stress in the pathogenesis of nonalcoholic steatohepatitis , antioxidant approaches have not been investigated sufficiently in the therapy of nonalcoholic steatohepatitis . Our aim was to determine whether vitamin E plus C therapy is effective in normalization of liver enzymes compared to ursodeoxycholic acid treatment in patients with fatty liver disease . METHODS This was an open-labeled , prospect i ve , r and omized study enrolling patients with histologically proven fatty liver disease who had chronically elevated alanine aminotransferase , despite a three-month reducing diet . Patients consuming alcohol ( more than 20 g/day ) were excluded . The patients were r and omly prescribed either oral vitamin E ( 600 IU/day ) plus vitamin C ( 500 mg/day ) or ursodeoxycholic acid ( 10 mg/kg/day ) . Patients were r and omized as two groups to receive vitamin E plus vitamin C combination ( 28 patients , 10 F ) or ursodeoxycholic acid treatment ( 29 patients , 13 F ) . RESULTS There was no significant change in body mass index before and after the treatment in both groups . At the end of six months of therapy , serum aspartate aminotransferase and aminotransferase levels significantly decreased in both treatment options . Vitamin E and C combination was more efficacious on serum aminotransferase levels than ursodeoxycholic acid , but the difference was not significant . Alanine aminotransferase decreased to normal levels in 17 of 27 ( 63 % ) and in 16 of 29 patients ( 55 % ) , respectively , in the two groups . Gamma-glutamyl transpeptidase decreased in patients receiving ursodeoxycholic acid , but no change was obtained in the vitamin-treated patients . CONCLUSIONS Vitamin E plus C combination treatment is a safe , inexpensive and effective treatment option in patients with fatty liver disease , with results comparable to those obtained with ursodeoxycholic acid . Since more effective new therapeutic options are lacking , patients with fatty liver disease should be encouraged to take vitamin E and C supplements , which are safe and affordable The effects of chronic alcohol consumption on the bowel flora and the potential therapeutic role of probiotics in alcohol-induced liver injury have not previously been evaluated . In this study , 66 adult Russian males admitted to a psychiatric hospital with a diagnosis of alcoholic psychosis were enrolled in a prospect i ve , r and omized , clinical trial to study the effects of alcohol and probiotics on the bowel flora and alcohol-induced liver injury . Patients were r and omized to receive 5 days of Bifidobacterium bifidum and Lactobacillus plantarum 8PA3 versus st and ard therapy alone ( abstinence plus vitamins ) . Stool cultures and liver enzymes were performed at baseline and again after therapy . Results were compared between groups and with 24 healthy , matched controls who did not consume alcohol . Compared to healthy controls , alcoholic patients had significantly reduced numbers of bifidobacteria ( 6.3 vs. 7.5 log colony-forming unit [CFU]/g ) , lactobacilli ( 3.15 vs. 4.59 log CFU/g ) , and enterococci ( 4.43 vs. 5.5 log CFU/g ) . The mean baseline alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , and gamma-glutamyl transpeptidase ( GGT ) activities were significantly elevated in the alcoholic group compared to the healthy control group ( AST : 104.1 vs. 29.15 U/L ; ALT : 50.49 vs. 22.96 U/L ; GGT 161.5 vs. 51.88 U/L ) , indicating that these patients did have mild alcohol-induced liver injury . After 5 days of probiotic therapy , alcoholic patients had significantly increased numbers of both bifidobacteria ( 7.9 vs. 6.81 log CFU/g ) and lactobacilli ( 4.2 vs. 3.2 log CFU/g ) compared to the st and ard therapy arm . Despite similar values at study initiation , patients treated with probiotics had significantly lower AST and ALT activity at the end of treatment than those treated with st and ard therapy alone ( AST : 54.67 vs. 76.43 U/L ; ALT 36.69 vs. 51.26 U/L ) . In a subgroup of 26 subjects with well-characterized mild alcoholic hepatitis ( defined as AST and ALT greater than 30 U/L with AST-to-ALT ratio greater than one ) , probiotic therapy was associated with a significant end of treatment reduction in ALT , AST , GGT , lactate dehydrogenase , and total bilirubin . In this subgroup , there was a significant end of treatment mean ALT reduction in the probiotic arm versus the st and ard therapy arm . In conclusion , patients with alcohol-induced liver injury have altered bowel flora compared to healthy controls . Short-term oral supplementation with B. bifidum and L. plantarum 8PA3 was associated with restoration of the bowel flora and greater improvement in alcohol-induced liver injury than st and ard therapy alone Background : Non-alcoholic steatohepatitis ( NASH ) is a clinicopathological entity that is being recognized more frequently in recent years . This study aim ed to evaluate the effects of Metformin , with and without a probiotic supplement on liver aminotransferases in patients with NASH . Methods : Sixty four patients 18 - 75 years with NASH confirmed by biopsy and histological assessment were enrolled to study . Patients were r and omized to one of the following treatments for 6 months : Group I , probiotic ( Protexin two tablets per day ) plus Metformin 500 mg two tablets per day ( Met/Pro ) , or group II , Metformin 500 mg two tablets per day plus two placebo tablet ( Met/P ) . After 6 month alanine aminotransferase ( ALT ) , aspartate aminotransferase , and ultrasound grading of NASH were assessed . Results : In group I , serum alanine aminotransferase ( ALT : 133.7 ± 70 vs. 45.2 ± 32.5 ; P < 0.00 ) , and aspartate aminotransferase activity ( AST : 123.1 ± 72 vs. 44.2 ± 33.9 ; P < 0.001 ) , and ultrasound grading of NASH ( P < 0.001 ) all decreased significantly by the end of the treatment period . In group II , while serum alanine aminotransferase ( ALT ) was not significantly reduced ( 118.4 ± 67.9 vs. 112.5 ± 68.7 ; P < 0.064 ) , aspartate aminotransferase activity ( AST : 125.3 ± 71 vs. 113.4 ± 71 ; P < 0.001 ) , and ultrasound grading of NASH did fall significantly ( P < 0.01 ) . Body mass index ( BMI ) , fasting blood sugar ( FBS ) , cholesterol , and triglyceride fell significantly in both groups . Conclusions : Probiotic combination with Metformin improves liver aminotransferases better than metformin alone in patients with NASH AIM To compare iron depletion to lifestyle changes alone in patients with severe nonalcoholic fatty liver disease ( NAFLD ) and hyperferritinemia , a frequent feature associated with more severe liver damage , despite at least 6 mo of lifestyle changes . METHODS Eligible subjects had to be 18 - 75 years old who underwent liver biopsy for ultrasonographically detected liver steatosis and hyperferritinemia , ferritin levels ≥ 250 ng/mL , and NAFLD activity score > 1 . Iron depletion had to be achieved by removing 350 cc of blood every 10 - 15 d according to baseline hemoglobin values and venesection tolerance , until ferritin < 30 ng/mL and /or transferrin saturation ( TS ) < 25 % . Thirty-eight patients were r and omized 1:1 to phlebotomy  ( n = 21 ) or lifestyle changes alone ( n = 17 ) . The main outcome of the study was improvement in liver damage according to the NAFLD activity score at 2 years , secondary outcomes were improvements in liver enzymes [ alanine aminotransferases ( ALT ) , aspartate aminotransferase ( AST ) , and gamma-glutamyl-transferases ( GGT ) ] . RESULTS Phlebotomy was associated with normalization of iron parameters without adverse events . In the 21 patients compliant to the study protocol , the rate of histological improvement was higher in iron depleted vs control subjects ( 8/12 , 67 % vs 2/9 , 22 % , P = 0.039 ) . There was a better improvement in steatosis grade in iron depleted vs control patients ( P = 0.02 ) . In patients followed-up at two years ( n = 35 ) , ALT , AST , and GGT levels were lower in iron-depleted than in control patients ( P < 0.05 ) . The prevalence of subjects with improvement in histological damage or , in the absence of liver biopsy , ALT decrease ≥ 20 % ( associated with histological improvement in biopsied patients ) was higher in the phlebotomy than in the control arm ( P = 0.022 ) . The effect of iron depletion on liver damage improvement as assessed by histology or ALT decrease ≥ 20 % was independent of baseline AST/ALT ratio and insulin resistance ( P = 0.0001 ) . CONCLUSION Iron depletion by phlebotomy is likely associated with a higher rate of improvement of histological liver damage than lifestyle changes alone in patients with NAFLD and hyperferritinemia , and with amelioration of liver enzymes BACKGROUND It is unknown whether diets with a high dietary total antioxidant capacity ( TAC ) can modify oxidative stress , low- grade inflammation , or liver dysfunction , all of which are risk factors for multiple sclerosis disease . This study assesses alanine amino-transferase ( ALT ) , aspartate-aminotransferase ( AST ) and gamma-glutamyl transferase ( GGT ) activities in MS patients treated with co-supplemented hemp seed and evening primrose oils as well as Hot-nature diet and the therapeutic potential this intervention . METHODS AND MATERIAL S In this double blind , r and omized trial , 100 MS patients with EDSS<6 were allocated into 3 groups : " group A " , who received co-supplemented hemp seed and evening primrose oils with advised Hot-nature diet ; " group B",who received olive oil ; and " group C " , who received the co-supplemented oils . Clinical ly , EDSS as well as serum level of liver enzymes ( GGT , AST , and ALT ) were assessed at baseline and after 6 months . RESULTS Mean follow-up was 180±2.9 SD days ( N=65 , 23 M and 42 F aged 34.25±8.07 years with disease duration of 6.80±4.33 years ) . There was no significant difference in the study parameters at baseline . Serum levels of liver enzymes ( GGT , AST , and ALT ) were serially monitored . Intervention was associated with liver function alteration in three groups . Significance decreased in EDSS score and the levels of liver enzymes were found in groups A and C , whereas elevated serum liver enzymes and EDSS score were observed in group B after the intervention . CONCLUSION Selecting foods according to their Total antioxidant capacity such as co-supplemented hemp seed and evening primrose oils with Hot-nature diet affects antioxidant intake and can have beneficial effects on improving EDSS score and activity of liver enzymes in RRMS patients OBJECTIVES : Nonalcoholic steatohepatitis ( NASH ) is a known metabolic disorder of the liver . No treatment has been conclusively shown to improve NASH or prevent disease progression . The function of L-carnitine to modulate lipid profile , glucose metabolism , oxidative stress , and inflammatory responses has been shown . The aim of this study was to evaluate the effects of L-carnitine 's supplementation on regression of NASH . METHODS : In patients with NASH and control subjects , we r and omly dispensed one 1-g L-carnitine tablet after breakfast plus diet and one 1 g tablet after dinner plus diet for 24 weeks or diet alone at the same dosage and regimen . We evaluated liver enzymes , lipid profile , fasting plasma glucose , C-reactive protein ( CRP ) , tumor necrosis factor (TNF)-α , homeostasis model assessment (HOMA)-IR , body mass index , and histological scores . RESULTS : At the end of the study , L-carnitine-treated patients showed significant improvements in the following parameters : aspartate aminotransferase ( P=0.000 ) , alanine aminotransferase ( ALT ) ( P=0.000 ) , γ-glutamyl-transpeptidase ( γ-GT ) ( P=0.000 ) , total cholesterol ( P=0.000 ) , low-density lipoprotein ( LDL ) ( P=0.000 ) , high-density lipoprotein ( HDL ) ( P=0.000 ) , triglycerides ( P=0.000 ) , glucose ( P=0.000 ) , HOMA-IR ( P=0.000 ) , CRP ( P=0.000 ) , TNF-α ( P=0.000 ) , and histological scores ( P=0.000 ) . CONCLUSIONS : L-carnitine supplementation to diet is useful for reducing TNF-α and CRP , and for improving liver function , glucose plasma level , lipid profile , HOMA-IR , and histological manifestations of NASH Background Previous observational studies have indicated that green tea ( GT ) consumption is associated with reduced mortality from cerebral infa rct ion but not with mortality from cerebral hemorrhage . Therefore , we hypothesized that GT exerts a direct antiatherosclerotic effect without any effect on hypertension . To investigate this hypothesis , we focused on adiponectin that seems to be among the several key players in atherosclerosis . Objective The objective of this r and omized controlled trial ( RCT ) was to assess whether the consumption of catechin-enriched GT affects serum adiponectin levels and cardiovascular disease ( CVD ) risk factors among apparently healthy subjects . Design A total of 51 individuals participated in the study . Eligible participants were r and omly assigned into GT consumption groups with either high catechin ( 400 mg/day ) or low catechin ( 100 mg/day ) . The study participants were asked to stop GT consumption for 2 weeks ( washout period ) , following which they were to start drinking the provided GT beverages everyday for 9 weeks . The outcome measures were changes in the adiponectin levels and CVD risk factors ( body weight , body mass index , waist circumference , blood pressure , total cholesterol , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , triglyceride , fasting plasma glucose , as well as aspartate aminotransferase , alanine aminotransferase , gamma-glutamyl transpeptidase , uric acid , and high-sensitive C-reactive protein ) . Results After intervention for 9 weeks , we found no significant difference between the high- and low catechin group with respect to changes in the serum adiponectin level : 0.35 µg/ml ( 95 % confidence interval ( CI ) : −1.03 , 1.74 ) . Also , no significant difference was observed between the high- and low catechin groups with respect to changes in any of the measured CVD risk factors . Conclusion This RCT showed no significant difference between the high- and low catechin groups with respect to changes in the serum adiponectin level and any CVD risk factors Background In patients with chronic hepatitis C ( CHC ) , obesity is involved in the pathogenesis of insulin resistance , fatty liver disease and progression of fibrosis . The objective of this study was to compare a normoglucidic low-calorie diet ( NGLCD ) with a low-fat diet ( LFD ) among participants with CHC . Aim ed to measure the impact of dietary changes in reduction of insulin resistance , obesity but also in steatosis and fibrosis . Methods R and omized , controlled trial in three medical centers with assessment s at baseline , 6 months and 12 months . Participants were patients over 35 years with chronic hepatitis C ( n = 120 ) with BMI over 25 kg/m2 . We evaluated the effects of NGLCD vs. LFD in weight management and metabolic improvement . The primary endpoint was to measure the impact of dietary changes through nutritional intervention in reversibility of insulin resistance , obesity , steatosis , and fibrosis . We performed anthropometric measurements , fasting glucose profile , serum lipids , liver profile , blood count at baseline , 6 and 12 months . Steatosis was evaluated using ultrasonographic criteria . Liver fibrosis was non-invasively assessed . Results After 6 and 12 months of intervention , both groups had a significant decrease in caloric consumption . At 6 months , weight loss was greater in the NGLCD group ( −5.02 ± 3.43 kg vs. −4.1 ± 2.6 kg ; p = 0.002 ) compared to the LFD group . At 1-year , however , weight loss was similar in both groups ( −3.9 ± 3.3 kg vs. −3.1 ± 2.6 kg ; p = 0.139 ) . At 12 months , fasting plasma glucose , fasting plasma insulin , and HOMA-IR had significant improvements in both groups . With both diets aspartate aminotransferase ( AST ) , alanine aminotransferase ( ALT ) , gamma-glutamyl transpeptidase ( GGT ) decreased with significant differences ; also there were significant improvements in AST/ALT ratio , Forns fibrosis index . The two diets were associated with reduction of both the prevalence and the severity of steatosis ( all p < 0.001 ) . At 12 months , total cholesterol , HDL-cholesterol , triglycerides improved in both groups ( all p < 0.05 ) . Conclusions The present study establishes the benefits of low-calorie diet and low-fat diet in management of patients with hepatitis C regarding improvement of insulin resistance , steatosis and also fibrosis . Overweight or obese patients with CHC undergoing a lifestyle intervention ( specific dietary intervention and physical activity ) for 1-year had significant improvements in body weight , lipid and hepatic profile . Trial registration PNCI2 - OBJECTIVE To improve hepatic function with Chinese herbal medicine ( CHM ) in patients after liver-carcinomectomy . METHODS One hundred and twenty patients were divided into the CHM group ( 61 patients ) and the control group ( 59 patients ) .  CHM therapy for relieving blood stasis , invigorating Spleen and soothing Liver was given to the CHM group after liver-carcinomectomy continuously for 5 - 6 weeks , and hepatic function was examined in all patients 8 - 9 weeks after the operation . RESULTS The hepatic function indexes , including alanine transaminase ( ALT ) , aspartate aminotrasferase ( AST ) , serum albumin ( ALB ) , gamma glutamyl transpeptidase ( GGTP ) , total bilirubin ( TBIL ) and direct bilirubin ( DBIL ) , were improved in the CHM group more significantly than those in the control group , all P < 0.05 . CONCLUSION Relieving blood stasis , strengthening Spleen and soothing Liver therapy has good effect in improving hepatic function after liver-carcinomectomy BACKGROUND No pharmacologic agents have been approved for the treatment of non-alcoholic steatohepatitis ( NASH ) that is common in our region . The present study was design ed to evaluate the efficacy of silymarin , a known herbal drug , in the treatment of NASH . METHODS This clinical -trial study was conducted on 64 patients with NASH who were r and omly divided as case group ( 33 ) and control group ( 31 ) . Abdominal sonography and persistent elevation in levels of aspartate aminotransferase ( AST ) and alanine aminotransferase ( ALT ) more than 1.2 times of the upper normal limit within the last six months were selected as inclusion criteria . They were advised to take low-fat , low carbohydrate diet , do regular sport activity to lose weight up to 4 Kg . Patients in the case group received 210 mg/day silymarin orally for 8 weeks and those in the control group received placebo . After 8 weeks , the patients were reevaluated and their AST and ALT levels were measured . This study was registered in the Iranian Registry of Clinical Trial ( www.i rct .ir ) with registration number ID : I RCT 201202159018N1 . RESULTS The mean age of patients in case and control groups was 43.6±8.3 and 39.4±10.5 years , respectively . Their BMI were 27.4±1.7 and 27.5±1.9 , respectively . Their weights were also 79±9.2 and 76.9±9.5 kg , respectively . Serum concentrations of ALT were 91.3±21.3 and 38.4±11.8 in case group before and after the study respectively , whiles the figures were 84.6±23.3 and 52.3±29 in the control group ( P=0.026 ) . The same trend was seen for AST ( P=0.038 ) . CONCLUSION The patients who had taken silymarin experienced more notable fall in hepatic enzymes OBJECTIVE We studied the relationship between liver enzymes and the development of diabetes in a general Japanese population . RESEARCH METHODS AND PROCEDURES A total of 1804 non-diabetic subjects 40 to 79 years of age were followed-up prospect ively for a mean of 9.0 years . RESULTS During the follow-up , 135 subjects developed diabetes .  In both sexes , the age-adjusted cumulative incidence of diabetes increased significantly with elevating quartiles of serum gamma-glutamyltransferase ( GGT )  and  alanine aminotransferase ( ALT ) levels . This pattern was also observed in aspartate aminotransferase ( AST ) quartiles for men but not for women . In multivariate analyses after adjusting for comprehensive risk factors and other liver enzymes , the risk of developing diabetes was significantly higher in the highest GGT quartile than in the lowest quartile [ odds ratio ( OR ) , 2.54 ; 95 % confidence interval ( CI ) , 1.03 to 6.26 for men ; OR , 5.73 ; 95 % CI , 1.62 to 20.19 for women ] . Similar results were observed in ALT quartiles ( OR , 2.32 ; 95 % CI , 0.91 to 5.92 for men ; OR , 4.40 ; 95 % CI , 1.38 to 14.06 for women ) but not in AST quartiles in either sex . Significant positive associations of GGT and ALT with diabetes were seen within each stratified category of risk factors , namely fasting insulin , BMI , waist-to-hip ratio , high-sensitivity C-reactive protein , and alcohol consumption . In receiver operating characteristic analyses , the areas under the receiver operating characteristic curve of GGT and ALT were significantly larger than that of AST , fasting insulin , waist-to-hip ratio , or C-reactive protein . DISCUSSION Our findings suggest that serum GGT and ALT concentrations are strong predictors of diabetes in the general population , independent of known risk factors Luseogliflozin , a selective inhibitor of sodium glucose co-transporter 2 ( SGLT2 ) , was previously shown to improve the blood glucose and hemoglobin A1c ( HbA1c ) levels of patients with type 2 diabetes in a clinical setting . Although patients with type 2 diabetes often have hepatic impairment , few reports have been published concerning the influence of luseogliflozin on HbA1c and hepatic function in patients with type 2 diabetes accompanied by hepatic impairment . The present study was undertaken to evaluate the influence of luseogliflozin on HbA1c and hepatic function in patients with type 2 diabetes divided into 2 groups according to hepatic function parameters ( a normal group and an elevated group ) . In this study , luseogliflozin significantly improved both HbA1c and body weight to similar extents in both the normal group and the elevated group , accompanied by marked reductions in the aspartate aminotransferase ( AST ) , alanine aminotransferase ( ALT ) , and γ-glutamyl transpeptidase ( γ-GTP ) levels . These results suggested that luseogliflozin can be safely used in patients with type 2 diabetes who also exhibit hepatic impairment . The results additionally suggest the possibility that luseogliflozin might be capable of alleviating hepatic impairment in patients with type 2 diabetes OBJECTIVE To study the activities of serum gamma-glutamyltransferase ( GGT ) , aspartate and alanine aminotransferases ( AST , ALT ) , and their ratio ( AST/ALT ) , mean erythrocyte cell volume ( MCV ) and urinary dolichol output in alcohol-abusing pregnant women , and compare the results to those of abstinent pregnant women . DESIGN Prospect i ve descriptive study . SETTING Special outpatient clinic for pregnant problem-drinkers in the department of Obstetrics and Gynaecology , Helsinki University Central Hospital , Finl and . SUBJECTS 25 pregnant women referred to the special clinic at between 12 and 24 weeks gestation , they consumed at least 150 g of ethanol weekly , and a control group of 20 abstinent pregnant women matched for age , parity and smoking habits . INTERVENTIONS The women were encouraged to visit the clinic at 2 - 4 week intervals . At each visit blood and urine sample s were obtained , and the women were interviewed on their alcohol consumption during the previous weeks and encouraged to abstain in the future . MEAN OUTCOME MEASURES Neonatal condition , fetal alcohol effects ( FAE ) in the newborn . Serum activities of GGT , AST and ALT , the AST/ALT ratio , the MCV , and the urinary concentration of dolichol in alcohol-abusing women with either healthy or FAE infants , compared with those of abstinent women with healthy infants . RESULTS Of the 25 alcohol-abusing women 13 gave birth to infants with FAE and 12 to healthy infants . All the women in the control group gave birth to healthy infants . GGT , AST and ALT activities were increased in all alcohol-abusing women , regardless whether the infant had FAE or not . GGT was the best of these markers , GGT activities above the 95th normal centile were found in 33 % of the sample s from all alcohol-abusing women . The AST/ALT ratio , MCV and urinary dolichol concentration were poor indicators of abusive drinking . CONCLUSIONS Maternal alcohol abuse is difficult to assess by laboratory tests . Of the commonly used and easily available tests , GGT proved to be the best in our study Extended-release naltrexone ( XR-NTX ) , an approved treatment for opioid or alcohol dependence , is a once-monthly injectable formulation of naltrexone .  Hepatotoxicity concerns have limited its use , necessitating further investigation . This study aims to examine hepatic enzyme levels in participants of 2 r and omized placebo-controlled trials ( RCTs ) of XR-NTX .  Hepatic transaminases were measured in 85 patients enrolled in RCTs of XR-NTX among HIV-infected prisoners , transitioning to the community and receiving treatment for either dependence on alcohol ( 52.9 % ) , opioids ( 44.7 % ) or both ( 16.5 % ) . Baseline characteristics included HCV co-infection ( 55.7 % ) , antiretroviral therapy ( 81 % ) , mental illness ( 39 % ) and receiving psychiatric medications ( 34.1 % ) .  Levels of aspartate aminotransferase ( AST ) , alanine aminotransferase ( ALT ) and gamma glutamyl transferase ( GGT ) were not statistically different between persons r and omized to placebo ( N=24 ) and XR-NTX ( N=61 ) arms . These results confirm that XR-NTX is safe to use among opioid and alcohol dependent HIV-infected released prisoners receiving ART with high rates of co-morbid HCV infection and mental illness BACKGROUND : Silymarin derived from silybum marianum ( milk thistle ) , a flowering member of the daisy family , may benefit liver function in people infected with the hepatitis C virus . The aims of this pilot study were to assess the efficacy and safety of silymarin on serum hepatitis C virus ( HCV ) RNA , serum aminotransferases ( ALT , AST ) levels , liver fibrosis and well-being in patients with chronic hepatitis C ( CHC ) . METHODS : This prospect i ve self-controlled trial study was conducted from March to September 2006 at Department of Gastroenterology , Isfahan University of Medical Sciences , Isfahan , Iran . 55 patients with HCV ( 10 female and 45 male ) with a mean age of 31.8 ± 6.4 years ( 10 - 67 years ) were participated in the study . Patients received 24 weeks of silymarin ( 630 mg/day ) . Baseline virological biochemical , liver fibrosis ( by a serum fibrosis markers , including YKL–40 and Hyaluronic acid ) , and SF-36 question naire were performed with biochemical tests repeated at the end of the treatment period . RESULTS : There was statistically difference in mean of ALT ( 108.7 ± 86.6 vs 70.3 ± 57.7 ) before and after the treatment ( p < 0.001 ) . The means of AST were 99.4 ± 139.7 and 59.7 ± 64.32 before and after the treatment with statistically differences ( p = 0.004 ) . After the treatment , nine patients were found with negative HCV-RNA ( p = 0.004 ) and statistically significant improvement in results of liver fibrosis markers were found only in fibrosis group ( p = 0.015 ) . Quality of life was improved significantly ( p < 0.001 ) . CONCLUSIONS : This study indicated that in patients with CHC  performing silymarin ( 650 mg/day ) for 6 months , improved serum HCV-RNA titer , serum aminotransferases ( ALT , AST ) , hepatic fibrosis and patient 's quality of life . More future studies are warranted
There was no significant change in the γGT levels .
Significant differences were not found .
CONCLUSION Silymarin minimally reduced , but without clinical relevance , the serum levels of ALT and AST .
AIM To evaluate the effect of silymarin on the serum levels of alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) and gamma glutamyl transpeptidase ( γGT ) in patients with liver diseases .