Anti-steatosis and anti-fibrosis effects of pomegranate peel
non-alcoholic fatty liver disease, NAFLD, fatty liver disease, inflammation, fatty liver, liver stiffness, metabolic syndrome, weight loss
FATTY LIVER, INFLAMMATION, LIVER FIBROSIS, NON-ALCOHOLIC FATTY LIVER DISEASE, INSULIN RESISTANCE, METABOLIC SYNDROME
Our study demonstrated a significant reduction in liver stiffness and the hepatorenal ultrasound index among patients receiving pomegranate peel supplements. In contrast, the placebo group exhibited a slight increase in these indices, which reached statistical significance. This discrepancy may be attributed to non-adherence to the recommended diet and physical activity in some individuals within the placebo group. Notably, no clinical trial investigating the effects of pomegranate peel on patients with non-alcoholic fatty liver disease has been published thus far. Therefore, our study relied on existing animal and human studies in this field.The findings of our study align with previous research examining the impact of pomegranate peel extract on liver fibrosis and fatty liver disease in animal models. For instance, Vi et al. administered pomegranate peel extract to rats with carbon tetrachloride-induced liver fibrosis for a duration of four weeks in 2015. They observed a reduction in aspartate and alanine transaminases, as well as total bilirubin levels. Additionally, they reported improvements in liver fibrosis by reducing markers such as hydroxyproline, procollagen type III, hyaluronic acid, laminin, and TGF-β1 [Also, our findings align with the research conducted by Liu et al., who demonstrated a reduction in liver fat content and inflammation following a 13-week administration of pomegranate peel extract in mice [Pomegranate peel has been attributed with various mechanisms underlying its anti-steatotic effects. These mechanisms encompass the enhancement of adiponectin signaling, modulation of genes involved in fatty acid oxidation pathways, regulation of lipid metabolism in adipose tissue, and mitigation of insulin resistance [Our study had limitations. Lack of complete adherence to the diet in some participants is one of the limitations of this research. However, it should be noted that this is not a weakness but rather one of the limitations of lifestyle modification studies, because according to the results of published studies, only 30% of patients participating in lifestyle modification programs for the treatment of NAFLD were able to achieve the desired weight loss at the end of the year. Also, according to our knowledge, when we had first started the study, there were no RCT on fatty liver disease. Thus, we had to calculate the pomegranate peel intervention dose from related animal study in fatty liver which was consider as both strength and limitation. The animal to human dose conversion formula suggested to use the median weight of 60 kg for participants for safety considerations. However; the mean weight of our population was unknown at the beginning of study. So, we used 1500 mg of pomegranate peel which considered as safe. However, our study had strengths. This was the first study evaluating the peel of pomegranate as a therapeutic supplement which in regular life is considered as a wastage. Thus, if proved, the supplement of PP will be inexpensive, affordable and environmental friendly. Our results along with the mentioned probable underlying mechanisms suggest a valuable insights in effects of pomegranate peel on fatty liver improvement and also metabolic syndrome risk factors. In addition we suggest to determine the precise molecular pathways, and the best effective dose of supplementation further studies are suggested.