The therapeutic effects of silymarin for patients with glucose/lipid metabolic dysfunction A meta-analysis

Abstract

Background: To comprehensively evaluate the treatment efficacy and safety of silymarin for patients with glucose/lipid metabolic dysfunction using a meta-analysis. Methods: A systematic literature search in PubMed, EMBASE and Cochrane Library databases was performed up to October 1, 2019. STATA 13.0 software was used to estimate pooled standardized mean difference (SMD) and 95% confidence interval (95% CI). Results: Sixteen studies involving 1358 patients were identified. Overall meta-analysis showed that compared with control, silymarin significantly reduced levels of fasting blood glucose (SMD: -1.27, 95% CI = [-1.78, -0.76]; P < .001), homeostatic model assessment for insulin resistance (SMD: -0.41, 95% CI = [-0.70, -0.12]; P = .005), hemoglobin A1c (SMD: -1.88, 95% CI = [-2.57, -1.20]; P < .001), total cholesterol (SMD: -1.13, 95% CI = [-1.82, -0.77]; P < .001), triglyceride (SMD: -0.37, 95% CI = [-0.69, -0.05]; P = .025), low-density lipoprotein-cholesterol (SMD: -1.30, 95% CI = [-1.93, -0.67]; P < .001), C-reactive protein (SMD: -0.63, 95% CI = [-1.01, -0.27]; P = .001), and increased high-density lipoprotein-cholesterol (SMD: 0.17, 95% CI = [0.05, 0.29]; P = .005), but had no impacts on function indicators of liver and kidney (alanine transaminase, aspartate aminotransferase, creatinine phosphokinase, creatinine) and the complication rate. Subgroup analyses indicated that insulin (which was negative in overall analysis) was significantly decreased in patients undergoing silymarin monotherapy (SMD: -2.03, 95% CI = [-3.03, -1.04]; P = .044) for more than 3 months (SMD: -0.01, 95% CI = [-0.25, -0.24]; P = .035). Conclusion: Supplementation of silymarin may be effective and safe for the management of diabetes mellitus and hyperlipidemia. Abbreviations: ALT = alanine transaminase, AST = aspartate aminotransferase, CI = confidence interval, CPK = creatinine phosphokinase, CRP = C-reactive protein, DM = diabetes mellitus, FBG = fasting blood glucose, FBI = fasting blood insulin, HbA1c = hemoglobin A1c, HDL-C = high-density lipoprotein-cholesterol, HOMA-IR = homeostatic model assessment for insulin resistance, IL = interleukin, LDL-C = low-density lipoprotein-cholesterol, MDA = malondialdehyde, OR = odds ratio, PRISMA = Preferred Reporting Items for Systematic Review and Meta-analysis, RCT = randomized controlled trial, SMD = standardized mean difference, TC = total cholesterol, TG = triglyceride, TNF = tumor necrosis factor.