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memberi makan tambahan berkhasiat untuk penyakit trần berlemak tidak berkaitan mencapai alkohol: meta‐analisis rangkaian

Background

The prevalence of non‐alcohol‐related fatty liver disease (NAFLD) varies between 19% and 33% in berbeda populations. NAFLD reduce life expectancy and increases dangers of liver cirrhosis, hepatocellular carcinoma, and the necessity for liver transplantation. Hesitation surrounds loved one benefits and also harms of variasi nutritional additionally in NAFLD. At this time no nutritional supplement is recommended for setiap orang with NAFLD.

Objectives

• To evaluate the benefits and harms of different nutritional supplements for treatment of NAFLD v a network meta‐analysis• To generate rankings of berbeda nutritional supplements according to milik mereka safety and efficacy

Search methods

We searched the Cochrane Central itu terdaftar of regulated Trials, MEDLINE, Embase, science Citation table of contents Expanded, Conference Proceedings quote Index‐Science, the dunia Health Organization worldwide Clinical Trials it is registered Platform, and also trials registers till February 2021 to determine randomised clinical trials in orang with NAFLD.

Selection criteria

We contained only randomised clinical trials (irrespective of language, blinding, or status) for people with NAFLD, regardless of of an approach of diagnosis, age and also diabetic statusnya of participants, or visibility of non‐alcoholic steatohepatitis (NASH). We excluded randomised clinical trials in i beg your pardon participants had actually previously gone through liver transplantation.

Data mengumpulkan and analysis

We carry out a network meta‐analysis through OpenBUGS using Bayesian approaches whenever kelayakan and calculated differences in treatments melihat hazard ratios (HRs), odds ratios (ORs), and perbandingan ratios with 95% credible intervals (CrIs) based upon an available‐case analysis, according to nationwide Institute of health and treatment Excellence Decision assistance Unit guidance.

Main results

We included in the formulir penilaian a bruto of 202 randomised clinical trials (14,200 participants). Nineteen trials menjadi at low hazard of bias. A kasar of 32 different interventions were compared in this trials. A total of 115 trials (7732 participants) menjadi included in one or much more comparisons. The staying trials did no report any kind of of the outcomes of interest for this review.

Follow‐up ranged from 1 month come 28 months. The follow‐up titik in trials that reported clinical outcomes to be 2 month to 28 months. Throughout this follow‐up period, clinical events related come NAFLD kemudian as mortality, liver cirrhosis, liver decompensation, liver transplantation, hepatocellular carcinoma, and liver‐related mortality menjadi sparse.

We did no calculate impact estimates because that mortality due to the fact that of thin data (zero events for at least one that the groups in the trial). No one of the trials reported that they measured all at once health‐related high quality of life lihat a validated scale. The proof is really uncertain around effects of intervensi on significant adverse events (number of people or sourse of events).

We are an extremely uncertain around effects on adverse occasions of paling of the additionally that we investigated, together the proof is of an extremely low certainty. However, rakyat taking PUFA (polyunsaturated fatty acid) may be much more likely to suffer an adverse occasion than itu not receiving an aktif intervention (network meta‐analysis results: OR 4.44, 95% CrI 2.40 come 8.48; low‐certainty evidence; 4 trials, 203 participants; straight evidence: OR 4.43, 95% CrI 2.43 to 8.42). People who untuk mengambil other supplements (a group that includes nutritional supplements various other than vitamins, fatty acids, phospholipids, and antioxidants) had higher numbers of adverse occasions than those not receiving an positif intervention (network meta‐analysis: perbandingan ratio 1.73, 95% CrI 1.26 come 2.41; 6 trials, 291 participants; straight evidence: rate ratio 1.72, 95% CrI 1.25 to 2.40; low‐certainty evidence).

Data were sparse (zero events in all groups in the trial) for liver transplantation, liver decompensation, and also hepatocellular carcinoma. So, us did not execute formal analysis for this outcomes. The evidence is an extremely uncertain about effects of other antioxidants (antioxidants various other than vitamins) contrasted to no active intervention top top liver cirrhosis (HR 1.68, 95% CrI 0.23 to 15.10; 1 trial, 99 participants; really low‐certainty evidence).

The proof is very uncertain around effects of interventions in any kind of of the staying comparisons, or data were sparse (with zero events in at the very least one the the groups), precluding officially calculations of effect estimates.

Data were probably because of the an extremely short follow‐up periode (2 months to 28 months). It takes follow‐up of 8 to 28 year to detect differences in mortality between rakyat with NAFLD and also the basic population. Therefore, that is unlikely that distinctions in clinical outcomes are detailed in trials providing less 보다 5 to 10 years of follow‐up.

Authors" conclusions

The evidence menunjukkan considerable uncertainty about effects that nutritional supplementation contrasted to no added intervention on all clinical outcomes for people with non‐alcohol‐related fat liver disease.

Accordingly, high‐quality randomised compare clinical trials with sufficient follow‐up room needed. We propose registry‐based randomised clinical trials or cohort many randomised clinical trials (study design in i m sorry multiple interventions are trialed within large longitudinal cohorts of patients to acquire efficiencies and align trials an ext closely to traditional clinical practice) comparing interventions such as vitamin E, prebiotics/probiotics/synbiotics, PUFAs, and no nutritional supplementation. The reason for the choice of intervensi is the kerusakan of these interventions on indirect outcomes, i beg your pardon may translate to clinical benefit. Outcomes in seperti trials have to be mortality, health‐related quality of life, decompensated liver cirrhosis, liver transplantation, and resource utilisation procedures including prices of intervention and decreased medical care utilisation after minimal follow‐up the 8 year (to find coherent differences in clinically necessary outcomes).