title: Essential phospholipids as a supportive adjunct in the management of patients with NAFLD.
abstract: OBJECTIVE
  Treatment of nonalcoholic fatty liver (NAFLD) is important because NAFLD patients have a 1.7-fold increase in standardised age and gender matched mortality. Currently treatment is based on life style modification and managing comorbid associating disease. Other medications remain experimental. Essential phospholipid (EPL) is a nutrient for the liver, helping to maintain vitality of cell membranes where the vast majority of liver activities are regulated. We performed a randomised open label study to evaluate EPL as an adjuvant nutrient to the treatment of primary NAFLD or NAFLD with comorbid disease.
  
  
  METHODS
  Three groups of NAFLD patients were recruited: lone (n=113), diabetes mellitus type 2 (n=107) and mixed hyperlipidaemia (n=104). Diagnosis was established by excluding other chronic liver diseases. A standard diet and physical activity plan were advised to all patients. 1800mg of EPL a day was given for 24weeks, followed by 900mg for 48weeks.
  
  
  RESULTS
  Essential phospholipid EPL led to a significant improvement of symptoms and a mean reduction of ALT of 50.8IU and AST of 46.1IU per patient (p<0.01). Abdominal ultrasonography indicated normalisation in 4.6% and a shift from grade II to grade I in 24% of patients. Liver stiffness measurement indicated an improvement in 21.1%, with a mean reduction in the LSM of 3.1K Pascal/patient. Reducing the dosage after six months led to a limited relapse in 43.8-63.2% of patients, for lone and NAFLD with co-morbid conditions.
  
  
  CONCLUSIONS
  Essential phospholipid (EPL) as a nutritional supplement resulted in a significant improvement in clinical parameters and transaminases for all NAFLD patients. Ultrasound and LSM revealed modest improvement. There is a need for uninterrupted maintenance to avoid relapse.
authors.affiliation: ADSC, Sharjah, United Arab Emirates.
authors.forename: Asad Izziddin Mustafa
authors.initials: AI
authors.lastname: Dajani
authors.affiliation: AMC, Dubai, United Arab Emirates.
authors.forename: Adnan M
authors.initials: AM
authors.lastname: Abu Hammour
authors.affiliation: HMC, Sharjah, United Arab Emirates.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Zakaria
authors.affiliation: DMMC, Dubai, United Arab Emirates.
authors.forename: Mazen R
authors.initials: MR
authors.lastname: Al Jaberi
authors.affiliation: MNC, Sharjah, United Arab Emirates.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Nounou
authors.affiliation: ASC, Sharjah, United Arab Emirates.
authors.forename: Abdul Ilah M
authors.initials: AI
authors.lastname: Semrin
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010743:Phospholipids / Q000627:therapeutic use*; D011446:Prospective Studies; D000637:Transaminases / Q000032:analysis; D055815:Young Adult
chemical_list: D010743:Phospholipids; D000637:Transaminases
keywords: EPL; Elastography; NAFLD; NASH; Transaminases