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Non-alcoholic fatty liver disease (NAFLD) includes a range of disorders from simple steatosis to non-alcoholic steatohepatitis. There is no proven drug treatment for NAFLD, and diet modification is considered part of the main line of treatment for this disease. The aim of this study was to investigate the efficacy of garlic supplementation in NAFLD patients. The effect of garlic powder supplementation on hepatic steatosis, liver enzymes and lipid profile was investigated in NAFLD patients. Ninety NAFLD patients were randomly assigned to take either a garlic powder supplement or a placebo for 12 weeks. The treatment group received four tablets of garlic daily (each tablet contained 400 mg garlic powder). The control group received four tablets of placebo (each placebo contained 400 mg starch). At the end of the study, hepatic steatosis was significantly reduced in the treatment group compared with the control group (P = 0·001). In addition, a significant decrease was seen in the serum concentration of alanine transaminase (P < 0·001), aspartate transaminase (P = 0·002), γ-glutamyltransferase (P = 0·003) as well as total cholesterol (P = 0·009), TAG (P < 0·001), HDL-cholesterol (P < 0·001) and LDL-cholesterol (P = 0·01) in the treatment group compared with the control group. No significant difference was seen between the two groups in serum concentration of alkaline phosphatase. Overall, garlic powder supplementation improved hepatic features and lipid profile among NAFLD patients.

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The prevalence of metabolic syndrome (MetS) is increasing. It is closely linked to nonalcoholic fatty liver disease. Garlic consumption as a strategy for the management of MetS has been suggested. We investigated the effect of garlic supplementation on MetS components, insulin resistance, fatty liver index (FLI), and appetite in subjects with MetS. Ninety subjects were assigned to receive 1,600 mg/d garlic powder or placebo for 3 months. The primary outcomes included MetS components. The secondary outcomes included insulin resistance, FLI, and appetite. Garlic supplementation compared with the placebo led to a significant increase in high density lipoprotein‐cholesterol (4.5 vs. −1.8, p < .001) and a significant reduction in waist circumference (−1.3 vs. 0.0, p = .001), diastolic blood pressure (−6.7 vs. 0.0, p < .001), systolic blood pressure (−7.7 vs. 0.5, p < .001), triglyceride (−40.0 vs. 0.1, p < .001), γ‐glutamyl transferase (−3.2 vs. 0.6, p = .01), FLI (−5.5 vs. 0.1, p < .001), insulin (−2.9 vs. −1.1, p < .001), homeostatic model of assessment for insulin resistance (−0.5 vs. −0.3, p < .001) and appetite (hunger: −11.7 vs. 1.7, p < .001; fullness: 10.0 vs. 0.3, p = .001; desire to eat: −6.7 vs. 2.1, p < .001; and ability to eat: −11.5 vs. −1.0, p < .001). Garlic improves MetS components, insulin resistance, FLI, and appetite.

Elevated levels of liver enzymes are the main markers of liver dysfunction. Liver enzymes are the important indicators of non-alcoholic fatty liver disease (NAFLD) in the general population. Previous randomized clinical trials (RCTs) investigated the effects of Mediterranean diet (MedDiet) as a plant-based diet on features of NAFLD like liver enzymes, but their results are contradictory. This study aimed to systematically review and meta-analyze RCTs investigating the effect of MedDiet on liver enzymes. PubMed, Web of Science, Scopus, and Google Scholar were searched until December 2020. A total of 10 RCTs (n=705 participants) evaluating the effect of MedDiet on liver enzymes including aspartate aminotransferase (AST), alanine transaminase (ALT) and γ-glutamyltransferase (GGT) were included. A random-effect model was used to estimates the pooled effect size. To evaluate the heterogeneity among the included studies, the Cochran’s Q-test and I-squared test were used. The MedDiet significantly reduced AST (weighted mean difference (WMD)= −0.38 IU/L; 95 % CI −0.73, −0.03 IU/L; P=0.03) and GGT (WMD= −0.16 IU/L; 95 % CI −0.32, −0.006 IU/L; P=0.04), but had no significant effect on ALT (WMD = −0.55 IU/L; 95 % CI −1.25, 0.13 IU/L; P=0.11). However, sensitivity analysis revealed that the overall effects of MedDiet on AST, GGT and ALT were significantly influenced by removing some studies. There was no publication bias based on Begg’s and Egger’s tests. Generally, MedDiet can improve liver enzymes. To better conclusion, further RCTs investigating the effect of MedDiet on liver enzymes, especially in patients with NAFLD are still required.