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Antioxidant supplements for liver diseases.
Cochrane Database Syst Rev. 2011 Mar 16CD

Abstract

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.

OBJECTIVES

To assess the benefits and harms of antioxidant supplements for patients with liver diseases.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science to January 2011. We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials.

SELECTION CRITERIA

We considered for inclusion randomised trials that compared antioxidant supplements (beta-carotene, vitamin A, C, E, and selenium) versus placebo or no intervention for autoimmune liver diseases, viral hepatitis, alcoholic liver disease, and cirrhosis (any aetiology).

DATA COLLECTION AND ANALYSIS

Four authors independently selected trials for inclusion and extracted data. Outcome measures were all-cause mortality, liver-related mortality, liver-related morbidity, biochemical indices at maximum follow-up in the individual trials as well as adverse events, quality-of-life measures, and cost-effectiveness. For patients with hepatitis B or C we also considered end of treatment and sustained virological response. We conducted random-effects and fixed-effect meta-analyses. Results were presented as relative risks (RR) or mean differences (MD), both with 95% confidence intervals (CI).

MAIN RESULTS

Twenty randomised 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 to 1.19, I(2) = 0%), or liver-related mortality (RR 0.89, 95% CI 0.39 to 2.05, I(2) = 37%). Stratification according to the type of liver disease did not affect noticeably the results. Antioxidant supplements significantly increased activity of gamma glutamyl transpeptidase (MD 24.21 IU/l, 95% CI 6.67 to 41.75, I(2) = 0%).

AUTHORS' CONCLUSIONS

We found no evidence to support or refute antioxidant supplements in patients with liver disease. Antioxidant supplements may increase liver enzyme activity.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Bjelakovic G
Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Copenhagen University Hospital, and Department of Internal Medicine - Gastroenterology and Hepatology, Medical Faculty, University of Nis, Zorana Djindjica 81, Nis, Serbia, 18000.
Gluud LL
No affiliation info available
Nikolova D
No affiliation info available
Bjelakovic M
No affiliation info available
Nagorni A
No affiliation info available
Gluud C
No affiliation info available

MeSH

AntioxidantsAscorbic AcidCause of DeathDietary SupplementsHumansLiver DiseasesOxidative StressRandomized Controlled Trials as TopicSeleniumVitamin AVitamin Ebeta Carotene

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

21412909

Citation

Bjelakovic, Goran, et al. "Antioxidant Supplements for Liver Diseases." The Cochrane Database of Systematic Reviews, 2011, p. CD007749.
Bjelakovic G, Gluud LL, Nikolova D, et al. Antioxidant supplements for liver diseases. Cochrane Database Syst Rev. 2011.
Bjelakovic, G., Gluud, L. L., Nikolova, D., Bjelakovic, M., Nagorni, A., & Gluud, C. (2011). Antioxidant supplements for liver diseases. The Cochrane Database of Systematic Reviews, (3), CD007749. https://doi.org/10.1002/14651858.CD007749.pub2
Bjelakovic G, et al. Antioxidant Supplements for Liver Diseases. Cochrane Database Syst Rev. 2011 Mar 16;(3)CD007749. PubMed PMID: 21412909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antioxidant supplements for liver diseases. AU - Bjelakovic,Goran, AU - Gluud,Lise Lotte, AU - Nikolova,Dimitrinka, AU - Bjelakovic,Marija, AU - Nagorni,Aleksandar, AU - Gluud,Christian, Y1 - 2011/03/16/ PY - 2011/3/18/entrez PY - 2011/3/18/pubmed PY - 2011/4/2/medline SP - CD007749 EP - CD007749 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - 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. OBJECTIVES: To assess the benefits and harms of antioxidant supplements for patients with liver diseases. SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science to January 2011. We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials. SELECTION CRITERIA: We considered for inclusion randomised trials that compared antioxidant supplements (beta-carotene, vitamin A, C, E, and selenium) versus placebo or no intervention for autoimmune liver diseases, viral hepatitis, alcoholic liver disease, and cirrhosis (any aetiology). DATA COLLECTION AND ANALYSIS: Four authors independently selected trials for inclusion and extracted data. Outcome measures were all-cause mortality, liver-related mortality, liver-related morbidity, biochemical indices at maximum follow-up in the individual trials as well as adverse events, quality-of-life measures, and cost-effectiveness. For patients with hepatitis B or C we also considered end of treatment and sustained virological response. We conducted random-effects and fixed-effect meta-analyses. Results were presented as relative risks (RR) or mean differences (MD), both with 95% confidence intervals (CI). MAIN RESULTS: Twenty randomised 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 to 1.19, I(2) = 0%), or liver-related mortality (RR 0.89, 95% CI 0.39 to 2.05, I(2) = 37%). Stratification according to the type of liver disease did not affect noticeably the results. Antioxidant supplements significantly increased activity of gamma glutamyl transpeptidase (MD 24.21 IU/l, 95% CI 6.67 to 41.75, I(2) = 0%). AUTHORS' CONCLUSIONS: We found no evidence to support or refute antioxidant supplements in patients with liver disease. Antioxidant supplements may increase liver enzyme activity. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/21412909/Antioxidant_supplements_for_liver_diseases_ DB - PRIME DP - Unbound Medicine ER -