The Effect of Artichoke Leaf Extract on Alanine Aminotransferase and Aspartate Aminotransferase in the Patients with Nonalcoholic Steatohepatitis

Hindawi Publishing Corporation International Journal of Hepatology Volume 2016, Article ID 4030476, 6 pages http://dx.doi.org/10.1155/2016/4030476 Clinical Study The Effect of Artichoke Leaf Extract on Alanine Aminotransferase and Aspartate Aminotransferase in the Patients with Nonalcoholic Steatohepatitis Vajiheh Rangboo,1 Mostafa Noroozi,2 Roza Zavoshy,3 Seyed Amirmansoor Rezadoost,4 and Asghar Mohammadpoorasl5 1 Department of Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran 3 Department of Nutrition, Faculty of Nutrition, Qazvin University of Medical Sciences, Qazvin, Iran 4 Shahid Chamran Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 5 Department of Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran 2 Correspondence should be addressed to Mostafa Noroozi; Received 11 October 2015; Revised 22 February 2016; Accepted 10 March 2016 Academic Editor: Roberto Lupi Copyright © 2016 Vajiheh Rangboo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Based on recent basic and clinical investigations, the extract of artichoke (Cynara scolymus) leaf has been revealed to be used for hepatoprotective and cholesterol reducing purposes. We aimed to assess the therapeutic effects of artichoke on biochemical and liver biomarkers in patients with nonalcoholic steatohepatitis (NASH). Methods. In a randomized double blind clinical trial, 60 consecutive patients suffering NASH were randomly assigned to receive Cynara scolymus extract (as 6 tablets per day consisting of 2700 mg extract of the herb) as the intervention group or placebo as the control group for two months. Results. Comparing changes in study markers following interventions showed improvement in liver enzymes. The levels of triglycerides and cholesterol were significantly reduced in the group treated with Cynara scolymus when compared to placebo group. To compare the role of Cynara scolymus use with placebo in changes in study parameters, multivariate linear regression models were employed indicating higher improvement in liver enzymes and also lipid profile particularly triglycerides and total cholesterol following administration of Cynara scolymus in comparison with placebo use. Conclusion. This study sheds light on the potential hepatoprotective activity and hypolipidemic effect of Cynara scolymus in management of NASH. This clinical trial is registered in the IRCT, Iranian Registry of Clinical Trials, by number IRCT2014070218321N1. 1. Introduction Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of disorders characterized by fatty infiltration in the liver and steatosis [1]. By developing oxidative stress, hepatocellular inflammation, and steatosis, the term was replaced by nonalcoholic steatohepatitis (NASH) that may culminate in cirrhosis and hepatocellular carcinoma [2, 3]. Within the last decade, prevalence of NASH has interestingly doubled especially in the Middle East, Far East, Africa, the Caribbean, and Latin America due to its close association with lifestyle disorders such as diabetes and obesity [4]. In this regard, the best treatment approaches for this phenomenon include weight loss, changes in dietary regimens, and lifestyle modifications. Also, in cases with documented hyperlipidemia or diabetes, use of insulin sensitizing and lipid lowering drugs can be also considered [5]. However, since NASH is a multifactorial disorder, single target based therapy has limited implications. Hence, the use of herbal medicine approach can be a promising alternative due to its multipronged mechanisms of action [6–8]. Artichoke (Cynara scolymus) is a plant frequently grown in Mediterranean countries that is rich in natural antioxidants and thus is used as a herbal drug [9]. Based on recent 2 basic and clinical investigations, the extract of artichoke leaf has been revealed to be used for hepatoprotective [10– 12], antimicrobial [13], and cholesterol reducing purposes [14]. Artichoke has been found to decrease the production of reactive oxygen species, the oxidation of low-density lipoproteins [15], lipid peroxidation [11], and protein oxidation and increase the activity of glutathione peroxidase [16]. In this regard, it seems that the use of this herb may be promising to treat NASH. The present study aimed to assess the therapeutic effects of artichoke on biochemical and liver biomarkers in patients with NASH. 2. Subjects and Methods 2.1. Study Population. In a randomized double blind clinical trial, 60 consecutive patients who suffered NASH (based on changes in liver enzymes and sonographic evidences) were included in the study. The main inclusion criteria were elevation of liver enzymes (>30 𝜇/L), any evidences of fatty liver in abdominal sonography, and the existence of at least one of these characteristics: total cholesterol > 200 mg/dL, high density lipoprotein (HDL) < 40 mg/dL for men and <50 mg/ dL for women, serum triglycerides level > 150 mg/dL, fasting blood sugar > 100 mg/dL, obesity defined as body mass index > 30 kg/m2 , or blood pressure > 130/85 mmHg. In this regard, the main exclusion criteria were daily alcohol consumption, diabetes mellitus type I, the existence of concomitant liver diseases such as hepatitis B or C, autoimmune hepatitis, Wilson, hemochromatosis, alpha-1 antitrypsin deficiency, or biliary obstruction, the use of vitamin C, livergol, hepatotoxic drugs, NASH inducing drugs such as amiodarone, calciumchannel blockers, or tamoxifen, pregnancy or breastfeeding, sensitivity to artichoke species, or any life-threatening disorders. The two groups were matched in terms of sex distribution (21 male and 9 female in both groups) and mean age (47.27 ± 8.12 years in intervention group and 49.83 ± 12.79 years in placebo group, 𝑃 = 0.357). The two groups were also similar in other baseline characteristics including weight, levels of liver enzymes, lipid profile, and fasting blood sugar on initial assessment. 2.2. Study Intervention. The baseline characteristics of patients were collected by interviewing and the study questionnaires were recorded. The patients were then randomly assigned to receive Cynara scolymus extract (as 6 tablets per day consisting of 2700 mg extract of the herb prepared in Dineh company, Qazvin, Iran) as the intervention group or placebo as the control group for two months (placebo was prepared from the same ingredient as treatment except Cynara scolymus extract). The randomization was done using computer generated random number tables. Both groups were advised to maintain regular physical activity (20 min walking within 5 days a week) and an appropriate dietary regimen (calculated based on patients’ weight, height, age (...truncated)