Essential phospholipids as a supportive adjunct in the management of patients with NAFLD

Background and study aims: Treatment of nonalcoholic fatty liver (NAFLD) is important because NAFLD patients have a 1.7-fold increase in standardised age and gender matched mortality. Currently treatment is based on life style modification and managing comorbid associating disease. Other medications remain experimental. Essential phospholipid (EPL) is a nutrient for the liver, helping to maintain vitality of cell membranes where the vast majority of liver activities are regulated. We performed a randomised open label study to evaluate EPL as an adjuvant nutrient to the treatment of primary NAFLD or NAFLD with comorbid disease. Patients and method: Three groups of NAFLD patients were recruited: lone (n = 113), diabetes mellitus type 2 (n = 107) and mixed hyperlipidaemia (n = 104). Diagnosis was established by excluding other chronic liver diseases. A standard diet and physical activity plan were advised to all patients. 1800 mg of EPL a day was given for 24 weeks, followed by 900 mg for 48 weeks. Results: Essential phospholipid EPL led to a significant improvement of symptoms and a mean reduction of ALT of 50.8 IU and AST of 46.1 IU per patient (p < 0.01). Abdominal ultrasonography indicated normalisation in 4.6% and a shift from grade II to grade I in 24% of patients. Liver stiffness measurement indicated an improvement in 21.1%, with a mean reduction in the LSM of 3.1 K Pascal/patient. Reducing the dosage after six months led to a limited relapse in 43.8-63.2% of patients, for lone and NAFLD with co-morbid conditions. Conclusion: Essential phospholipid (EPL) as a nutritional supplement resulted in a significant improvement in clinical parameters and transaminases for all NAFLD patients. Ultrasound and LSM revealed modest improvement. There is a need for uninterrupted maintenance to avoid relapse. (C) 2015 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.