# Nutritional Support for Liver Diseases
## 2 Nutritional Support for Liver Diseases
### Cholangiocarcinoma
#### 2.2.3 Supplementation  
The role of supplementation in the nutrition of NAFLD patients is still not well understood. The ESPEN guidelines [39] point to the role of vitamin E supplementation (recommendation grade B) in patients with non-alcoholic steatohepatitis (NASH). However, there are no guidelines for NAFLD patients. In turn, supplementation with vitamin C, antioxidants (including resveratrol, anthocyanin, and coenzyme Q-10) or choline (no deficiency), omega-3, probiotics, and synbiotics is not recommended (zero recommendation, 100% consensus for all) [39]. However, it is worth noting that the lack of recommendations does not mean the potential effectiveness of the above-mentioned supplements; further research is required. A meta-analysis by [PERSON] et al. [53] showed that omega-3 supplementation significantly reduced liver fat when compared to a placebo (pooled risk ratio 1.52; 95% confidence interval (CI) 1.09 to 2.13). Supplementation also significantly improved the triglyceride pool, total cholesterol, _High-Density lipoprotein_ (HDL), and body mass index (BMI), with a pooled mean difference and 95% CI of \(-\)28.57 (\(-\)40.81 to \(-\)16.33), \(-\)7.82 (\(-\)14.86 to \(-\)0.79), 3.55 (1.38 to 5.73), and \(-\)0.46 (\(-\)0.84 to \(-\)0.08), respectively. In a study conducted by [PERSON] et al. [54], there was a significant improvement after dietary chia supplementation. Chia seeds (_Salvia hispanica_) are commonly known as a dietary source of omega-3 fatty acids. [PERSON] et al. demonstrated that dietary chia supplementation decreases visceral adipose tissue (9%), body weight (1.4%), total cholesterol (2.5%), non-HDL (3.2%), and circulating free fatty acids (FFA) (8%) [54]. The effects of omega-3 fatty acids are presented in Figure 1.  
Additionally, the researchers observed statistically significant (\(p<0.05\)) NAFLD regression of over 52% in the intervention group. This effect may also be mediated by a much greater (over 55%) total dietary fiber consumption, as Chia is also a good source of dietary fiber [54]. [PERSON] et al. investigated 1.0 \(\times\) 109 CFU/d of probiotic strain Bifidobacterium animalis (subspecies lactis BB-12), combined with fructo-oligosaccharides (FOSs) with maltodextrin (8000 mg/day) [55]. Over 44-61 weeks in 104 NAFLD patients, the effect of the symbiotic supplementation vs. the control was not significantly different \(p=0.30\), and the between-group difference was 2.3% [55]. To date, there is no strong recommendation for dietary supplementation in NAFLD. Further studies are needed.  
Many studies also indicated that some plant parts could have prebiotic and hepatocyte properties: Table 1.  
Figure 1: The effects of omega-3 fatty acids intake in NAFLD patients (BMI—body mass index; FFA—free fatty acids; HDL—high-density lipoprotein; non-HDL—non-high-density lipoprotein; TC—total cholesterol; TG—triacylglyceroldes. (Created with BioRender.com).  
\begin{table}
\begin{tabular}{c c c c c} \hline
**Common Name (Latin Name)** & **Family** & **Used Part** & **Materials** & **References** \\ \hline Garlic (_Allimen sativum_) & _Alliscuce_ & bulb & Rats & [56; 57; 58] \\ Onion (_Allimen qua_) & _Alliscuce_ & bulb & Rats & [57; 59; 60; 61; 62;