Flaxseed, due to its nutritional components, can be considered as a promising adjunct intervention for reducing the risk of weight-related metabolic abnormalities such as dyslipidemia, insulin resistance, cardiovascular risk factors and it is a good choice for weight loss. Hesperidin is an antioxidant flavonoid found in high concentrations in citrus. Together, flaxseed, because of the high content of omega-3 and fiber and its other components, and hesperidin, due to its potent antioxidant activity can be an effective combination in managing NAFLD. A randomized, controlled, open-label clinical trial to investigate the efficacy of flax-hes supplementation in patients with NAFLD was conducted. 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. CAP score, as an indicator of hepatic steatosis, reduced considerably in all intervention groups, while no significant differences were detected among four groups. These findings indicate the significant effects of lifestyle modification on hepatic steatosis, which diluted the effects of supplements on liver steatosis. Only flaxseed supplementation could ameliorate the hepatic fibrosis. In conclusion, the study confirmed that hesperidin and flaxseed supplementation, alone or in combination together, improved glucose and lipid metabolism, while reduced some inflammatory factors and CAP score in NAFLD patients. The synergistic effects of their combination were observed on plasma glucose concentration and HOMA-IR.
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