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Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) affects more than one-quarter of the global population. Due to the lack of approved chemical agents, many patients seek treatment from traditional Chinese medicine (TCM) formulas. A variety of systematic reviews have been published regarding the e...

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Autores principales: Dai, Liang, Zhou, Wen-Jun, Zhong, Linda L D, Tang, Xu-Dong, Ji, Guang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809658/
https://www.ncbi.nlm.nih.gov/pubmed/33511176
http://dx.doi.org/10.12998/wjcc.v9.i1.102
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author Dai, Liang
Zhou, Wen-Jun
Zhong, Linda L D
Tang, Xu-Dong
Ji, Guang
author_facet Dai, Liang
Zhou, Wen-Jun
Zhong, Linda L D
Tang, Xu-Dong
Ji, Guang
author_sort Dai, Liang
collection PubMed
description BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) affects more than one-quarter of the global population. Due to the lack of approved chemical agents, many patients seek treatment from traditional Chinese medicine (TCM) formulas. A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD. AIM: To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD. METHODS: Seven databases were systematically searched from their inception to 28 February 2020. The search terms included “non-alcoholic fatty liver disease,” “Chinese medicines,” “systematic review,” and their synonyms. Systematic reviews involving TCM formulas alone or in combination with conventional medications were included. The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2 (AMSTAR 2) and Risk of Bias in Systematic Review (ROBIS). The quality of outcomes was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Seven systematic reviews were ultimately included. All systematic reviews were conducted based on randomized controlled trials and published in the last decade. According to the AMSTAR 2 tool, one systematic review was judged as having a moderate confidence level, whereas the other studies were rated as having a low or extremely low level of confidence. The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns. According to the GRADE system, only two outcomes were determined as high quality; namely, TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement, and TCM formulas were superior to antioxidants in alanine aminotransferase normalization. Other outcomes were downgraded to lower levels, mainly because of heterogeneity among studies, not meeting optimal information sample size, and inclusion of excessive numbers of small sample studies. Nevertheless, the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness. CONCLUSION: The quality of available systematic reviews was not satisfactory. Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.
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spelling pubmed-78096582021-01-27 Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews Dai, Liang Zhou, Wen-Jun Zhong, Linda L D Tang, Xu-Dong Ji, Guang World J Clin Cases Systematic Reviews BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) affects more than one-quarter of the global population. Due to the lack of approved chemical agents, many patients seek treatment from traditional Chinese medicine (TCM) formulas. A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD. AIM: To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD. METHODS: Seven databases were systematically searched from their inception to 28 February 2020. The search terms included “non-alcoholic fatty liver disease,” “Chinese medicines,” “systematic review,” and their synonyms. Systematic reviews involving TCM formulas alone or in combination with conventional medications were included. The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2 (AMSTAR 2) and Risk of Bias in Systematic Review (ROBIS). The quality of outcomes was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Seven systematic reviews were ultimately included. All systematic reviews were conducted based on randomized controlled trials and published in the last decade. According to the AMSTAR 2 tool, one systematic review was judged as having a moderate confidence level, whereas the other studies were rated as having a low or extremely low level of confidence. The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns. According to the GRADE system, only two outcomes were determined as high quality; namely, TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement, and TCM formulas were superior to antioxidants in alanine aminotransferase normalization. Other outcomes were downgraded to lower levels, mainly because of heterogeneity among studies, not meeting optimal information sample size, and inclusion of excessive numbers of small sample studies. Nevertheless, the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness. CONCLUSION: The quality of available systematic reviews was not satisfactory. Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications. Baishideng Publishing Group Inc 2021-01-06 2021-01-06 /pmc/articles/PMC7809658/ /pubmed/33511176 http://dx.doi.org/10.12998/wjcc.v9.i1.102 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Systematic Reviews
Dai, Liang
Zhou, Wen-Jun
Zhong, Linda L D
Tang, Xu-Dong
Ji, Guang
Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews
title Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews
title_full Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews
title_fullStr Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews
title_full_unstemmed Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews
title_short Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews
title_sort chinese medicine formulas for nonalcoholic fatty liver disease: overview of systematic reviews
topic Systematic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809658/
https://www.ncbi.nlm.nih.gov/pubmed/33511176
http://dx.doi.org/10.12998/wjcc.v9.i1.102
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