Traditional Indian Medicine Improves Clinical Outcome in Non-alcoholic fatty Liver diseases - A Systematic Review and Meta-analysis

Background: Non- Alcoholic Fatty Liver Disease (NAFLD) is a rapidly emerging liver disease linked strongly to metabolic syndrome. In the absence of specific pharmacological agents for the effective treatment of NAFLD, current treatment mainly focuses on lifestyle and dietary modifications. Several agents referenced in Ayurvedic texts have shown promising effects in patients over centuries of use. But the outcomes reported by various randomized clinical trials (RCTs) for the efficacy of herbs in non-alcoholic fatty liver disease (NAFLD) are conflicting. Objective: This study aims to systematically review and conduct meta-analysis of the available evidence to evaluate the efficacy and safety of Ayurveda-referenced drugs.  Methodology: The electronic databases PubMed, Web of Science, Embase, Cochrane library, and ARP were searched up to May 2022 to identify relevant studies. Quality of studies was evaluated using modified Jadad Scale. Risk of bias was assessed using Cochrane risk of bias tool. Result: The search retrieved 1352 studies, but only 18 studies were finally evaluated. Statistical analysis showed significant reduction in grades of fatty liver (RR: 2.42, 95% CI; 1.52, 3.86), AST (SMD: -0.91, 95% CI; -1.04, 0.08;) and ALT (SMD = − 0.91; 95% CI; − 1.53, − 0.28; P < 0.00001). Conclusion: Ayurveda drugs have shown positive results in managing NAFLD, as evidenced by the limited available data. More quality-based RCT’s using standardized Ayurveda drugs with large sample sizes and taking histological outcomes into consideration must be conducted to generate stronger evidence.