Abstract
Background/objectives: Non-alcoholic fatty liver disease (NAFLD) is growing in prevalence globally and no definitive evidence for any approved pharmacological approaches for patients with NAFLD has been found yet. This study was aimed to assess the clinical effects of flaxseed and hesperidin in patients with NAFLD. Subjects/methods: In this randomized, controlled, clinical trial, one hundred eligible patients with NAFLD were enrolled and randomly assigned to four dietary intervention groups including lifestyle modification program (control), lifestyle modification program with 30 g whole flaxseed powder, lifestyle modification program with 1 g hesperidin supplementation, and lifestyle modification program with combination of 30 g flaxseed and 1 g hesperidin (flax-hes) for 12 weeks. The changes in anthropometric parameters, metabolic profiles of glucose and lipids, inflammatory biomarkers and hepatic steatosis and fibrosis were evaluated. Results: After the 12-week dietary interventions, significant reductions in body mass index, glucose hemostasis parameters and hepatic steatosis were observed in all groups. Repeated measures analysis of variance revealed a significant effect for time relative to almost all paraclinical parameters. Post hoc analysis with Bonferroni correction revealed that the three intervention groups experienced significant decreases in plasma levels of alanine aminotransferase, indices of insulin resistance and insulin sensitivity, fasting glucose and fatty liver index compared to control (p < 0.008). Conclusions: In conclusion, our study confirmed that hesperidin and flaxseed supplementation improved glucose and lipid metabolism, while reduced inflammation and hepatic steatosis (controlled attenuation parameter) in NAFLD patients. The synergistic effects of their combination were observed on plasma glucose concentration and HOMA-IR.
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Key Points
This study speculated that concomitant administration of hesperidin and flaxseed (flax-hes) may point to the multifactorial nature of NAFLD and reverse allied metabolic abnormalities. In the present study, a randomized, controlled, open-label clinical trial was used to investigate the efficacy of flax-hes supplementation in patients with NAFLD. The results showed that taking hesperidin or flaxseed or a combination can increase the effectiveness of lifestyle modifications in NAFLD management.
In the present study, amelioration of dyslipidemia in response to supplementation with hesperidin and/or flaxseed was achieved. No differences were seen in control group, while in the other three groups, plasma levels of TG, TC, and LDL-C decreased significantly during 12 weeks. HDL-C levels also increased significantly in the flaxseed group.
An interesting finding of this study was that only flaxseed supplementation could ameliorate the hepatic fibrosis, which was detected by reduction in Fibroscan KPa score. This effect might be due to high n-3 content of flaxseed, which can be placed in cellular membrane phospholipids. The study confirmed that hesperidin and flaxseed supplementation, alone or in combination together, improved glucose and lipid metabolism.