1 | INTRODUCTION
The liver plays central roles in the maintenance of body homeostasis and
is important to multiple metabolic functions and physiological processes
such as bile production, energy generation, vitamin storage, and the
metabolism of carbohydrates, proteins, and lipids [1]. Fatty liver
disease is becoming progressively prevalent in numerous parts of the
world, affecting about 25% of people globally [2]. High
concentrations of alanine aminotransferase (ALT) and aspartate
aminotransferase (AST) in hepatocytes are used as biochemical indicators
of hepatocellular disease [3]. Results from several studies suggest
that certain vitamins, herbs and dietary supplements may help lessen
liver fat and reduce the risk of liver disease progression [4].
Furthermore, among supplements that
may ameliorate fatty liver, silymarin; berberine has been great of
interest [5-9]. BBR is an isoquinoline derivative alkaloid isolated
from Rhizoma Coptidis (RC). The composition of BBR in RC is about 5.2%
to 7.7%. BBR has been widely used as a drug in traditional Indian and
Chinese medicinal plants [10, 11]. This plant is useful as
cholesterol-lowering action and anti-hyperglycemic effect [12-16].
But BBR due to the presence of P-glycoprotein (P-gp) have low oral
bioavailability. It has been recently formulated along with silymarin,
and this component rich in
flavolignanes (60–80%) and
flavolignanes inhibits the transport of P-gp substrates, thus improving
oral bioavailability of BBR [17]. Then, silymarin considered a fine
candidate for combine with berberis aristate to improve the efficacy of
liver function [18].
BBR by anti-dyslipidemic [19,
20], anti-hyperglycemic [20]
and anti-inflammatory effect [21-25] may play a role in improving
the nonalcoholic fatty liver disease
(NAFLD). Silymarin has
anti-inflammatory effect such as reduction of Tumor Necrosis Factor
Alpha (TNF-α) [26, 27], and alleviate oxidative stress by
(Superoxide Dismutase (SOD), Glutathione (GSH), Glutathione Peroxidase
(GPx) activity) [28], antifibrotic activity [26]. Also BBR
inhibited the 5-lipoxygenase pathway [29]. In the past study we
observed improve in lipid and glucose profile with silymarin; berberine
[30]. Also, BBR [31, 32] and silymarin [33-36] lonely effect
on the liver function and improve in liver enzymes.
The aim of our meta‐analysis was to systematically summarize the effects
of the BBR–silymarin supplementation on liver enzymes using randomized
controlled trials (RCTs).