Non-alcoholic fatty liver disease
Hepatic fat accumulation in patients without significant alcohol intake. Treatment focuses on weight loss and metabolic risk factor control.
ICD-10 K76.010 drugs
Also known as: NAFLD, MAFLD, Hepatic steatosis
Drugs used for this condition
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DAdemetionineNot recommended · Amino acids and derivatives. Hepatoprotective agentSAMe is heavily marketed at retail as a liver remedy. For non-alcoholic fatty liver disease (NAFLD/MASLD) and steatohepatitis there is no evidence base with histological steatohepatitis resolution or fibrosis endpoints. EASL-EASD-EASO 2024 list 7–10 % weight loss via Mediterranean diet and physical activity first-line for MASLD; with concomitant T2DM – SGLT2i and GLP-1 RA; for confirmed steatohepatitis – resmetirom (Rezdiffra, FDA 2024). SAMe is not in MASLD guidelines. The interventions with proven benefit in this condition are weight loss and correction of cardiometabolic risk factors, so SAMe should not replace them.
- DArtichoke (Cynara scolymus)Not recommended · Herbal preparation, supplement. In EU – traditional herbal medicinal product (EMA HMPC). In Russia OTC product Hofitol is registeredArtichoke is sold as a «natural hepatoprotector» and «liver detox agent» for non-alcoholic fatty liver disease (NAFLD). Several small RCTs documented moderate ALT and AST reductions with artichoke extract 300–600 mg/day in NAFLD patients, but quality is low, samples small, and hard outcomes (fibrosis on biopsy or elastography, liver mortality) were not assessed. AASLD 2023 and EASL-EASD-EASO 2024 list as first-line for NAFLD/MASLD: 7–10% weight loss via Mediterranean diet and physical activity, control of metabolic risk factors (diabetes, dyslipidaemia, hypertension); pharmacotherapy in confirmed NASH includes resmetirom (Rezdiffra, FDA 03/2024), pioglitazone in T2DM patients, GLP-1 receptor agonists semaglutide. Herbal extracts including artichoke are not in international guidelines. If artichoke was recommended for NAFLD instead of dietary correction, physical activity and workup (HbA1c, lipid panel, FibroScan), consider seeking a second opinion from a gastroenterologist.
- DBetaine (trimethylglycine, TMG)Not recommended · Methyl donor; agent for the alternative homocysteine remethylation pathwayHigh-dose betaine (10–20 g/day) was studied in non-alcoholic fatty liver disease. Several small studies reported reduced ALT and improved histology, but larger randomised trials did not confirm the effect. EASL 2024 and AASLD 2023 do not recommend it for MASLD/NAFLD. High doses raise plasma methionine, which may worsen the lipid profile and cause unpleasant body odour. Evidence-based treatment of fatty liver targets weight, diet, glucose and lipid control.
- DEssential phospholipidsNot recommended · Liver therapy (local classification)Essential phospholipids are cell-membrane components marketed as a way to "restore" the liver in non-alcoholic fatty liver disease. They have not shown convincing benefit for this condition, and there is no solid evidence base for such use. What actually helps is weight loss, dietary changes and physical activity, plus control of blood sugar and lipids under medical supervision when those are affected. The substance itself is harmless in this role, but it should not be taken instead of approaches with proven benefit, or you risk missing the treatment you need.
- DSilymarin (Silybum marianum)Not recommended · Plant antioxidant from milk thistle fruits; IV silibinin is an antidote in Amanita phalloides poisoningMilk thistle is often advised for «fatty liver» on ultrasound. Meta-analyses show weak and inconsistent effects on ALT and AST (5–10 IU/L reduction) and no change in steatosis grade on imaging. EASL 2024 and AASLD 2023 do not mention silymarin in MASLD/NAFLD management standards. Evidence-based options are 7–10% weight loss, Mediterranean diet, glucose and lipid control, and in confirmed MASH resmetirom or semaglutide as prescribed. Concerns about a fatty liver ultrasound finding require full assessment by a gastroenterologist, not a supplement course.
- DTauroursodeoxycholic acid (TUDCA)Not recommended · Bile acid, conjugate of ursodeoxycholic acid with taurine. RX medicine in Japan; in EU/US sold as supplement. AEMPS does not register it as a medicine. Not registered in Russia via GRLSTUDCA is sold in the biohacking segment as a «gold standard liver shield» for non-alcoholic fatty liver disease (NAFLD/MASLD). Human evidence base is small: isolated small phase II RCTs in 20–40 patients showed improved insulin sensitivity and reduced endoplasmic reticulum stress markers, but hard outcomes (fibrosis, portal hypertension, liver mortality) were not assessed. AASLD 2023 and EASL-EASD-EASO 2024 list as first-line in NAFLD/MASLD: 7–10% weight loss, Mediterranean diet and physical activity; confirmed NASH includes resmetirom (Rezdiffra, FDA 03/2024), pioglitazone in T2DM, GLP-1 receptor agonists semaglutide. TUDCA is not in NAFLD international guidelines. If TUDCA was recommended for NAFLD instead of dietary correction, physical activity and workup (HbA1c, lipid panel, FibroScan), consider seeking a second opinion from a hepatologist.
- DTocotrienolsNot recommended · Natural vitamin E forms (4 isomers α, β, γ, δ)Tocotrienols are marketed for NAFLD and NASH based on small open-label trials of ALT reduction. AASLD 2023 in biopsy-proven NASH recommends α-tocopherol 800 IU/day (moderate evidence) in non-diabetic patients; for tocotrienols the guideline makes no recommendation. Cochrane 2017 on vitamin E in NAFLD analysed α-tocopherol data; high-quality RCTs of tocotrienols are absent. First-line NAFLD therapy is weight loss (5–10%), physical activity, T2DM and hypertension control; in proven NASH-fibrosis, pioglitazone or semaglutide per hepatologist judgement. If tocotrienols were recommended «for the liver», consider seeking a second opinion.
- DUrsodeoxycholic acidNot recommended · Bile acid preparationsIn metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD), ursodeoxycholic acid monotherapy has not demonstrated efficacy per EASL 2024 and AASLD 2023. Biochemical improvements occur but do not translate into histological or clinical outcomes (fibrosis, cirrhosis, cardiovascular mortality). Use in this niche is unjustified. MASLD management rests on 7–10 % weight loss, physical activity, GLP-1 agonists in coexisting T2D, and resmetirom in MASH with fibrosis.
- FGlycyrrhizic acid + phospholipidsNot recommended · Liver therapy (local classification, «hepatoprotectors»)For NAFLD, AASLD 2023 and EASL 2021 guidelines recommend weight loss, diabetes and dyslipidaemia control, and alcohol cessation. Phosphogliv and other 'hepatoprotectors' are not included.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit