Meta-analysis: antioxidant supplements for liver diseases – the Cochrane Hepato-Biliary Group
Article first published online: 22 MAY 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 32, Issue 3, pages 356–367, August 2010
How to Cite
Bjelakovic, G., Gluud, L. L., Nikolova, D., Bjelakovic, M., Nagorni, A. and Gluud, C. (2010), Meta-analysis: antioxidant supplements for liver diseases – the Cochrane Hepato-Biliary Group. Alimentary Pharmacology & Therapeutics, 32: 356–367. doi: 10.1111/j.1365-2036.2010.04371.x
- Issue published online: 6 JUL 2010
- Article first published online: 22 MAY 2010
- Publication data Submitted 4 April 2010 First decision 8 April 2010 Resubmitted 17 May 2010 Accepted 18 May 2010 Epub Accepted Article 22 May 2010
Aliment Pharmacol Ther 2010; 32: 356–367
Background Several liver diseases have been associated with oxidative stress. Accordingly, antioxidants have been suggested as potential therapeutics for various liver diseases. The evidence supporting these suggestions is equivocal.
Aim To assess the benefits and harms of antioxidant supplements for patients with liver diseases.
Methods We identified trials through electronic and manual searches until August 2009. We included randomized trials comparing antioxidant supplements (beta-carotene, vitamin A, C, E and selenium) vs. placebo or no intervention for autoimmune liver diseases, viral hepatitis, alcoholic liver disease and cirrhosis (any aetiology). Random-effects and fixed-effect meta-analyses were conducted. Results were presented as relative risks (RR), or mean difference (MD), both with 95% confidence intervals (CI).
Results Twenty randomized trials with 1225 participants were included. The trials assessed beta-carotene (3 trials), vitamin A (2 trials), vitamin C (9 trials), vitamin E (15 trials) and selenium (8 trials). The majority of the trials had high risk of bias and showed heterogeneity. Overall, the assessed antioxidant supplements had no significant effect on all-cause mortality [relative risk (RR) 0.84, 95% confidence interval (CI) 0.60–1.19, I2 = 0%] or liver-related mortality (RR 0.89, 95% CI 0.39–2.05, I2 = 37%). Stratification according to the type of liver disease assessed did not affect the conclusions. Antioxidant supplements significantly increased the activity of gamma glutamyl transpeptidase (MD 24.21 IU/L, 95% CI 6.67–41.75, I2 = 0%).
Conclusions We found no evidence to support or refute antioxidant supplements in patients with liver disease. Antioxidant supplements may increase liver enzymes.