Ziziphus jujube Fruit Supplementation Improves Liver Enzymes, Lipid Profile, and Hepatic Steatosis but Not Fasting Blood Glucose in Patients With NAFLD : A Randomized Contr

ABSTRACT

Non‐alcoholic fatty liver disease (NAFLD) is characterized by the excessive accumulation of triglycerides within hepatocytes. Ziziphus jujube fruit (ZJF), a medicinal plant with well‐documented antioxidant and anti‐inflammatory properties, has shown hepatoprotective effects in preclinical studies. This study aimed to investigate the effects of ZJF powder supplementation on fasting blood glucose (FBG), lipid profile, liver enzyme levels, and the severity of hepatic steatosis in patients with NAFLD. In this single‐blind, randomized controlled clinical trial, 88 patients diagnosed with NAFLD were recruited. Participants were randomly assigned to either the intervention group, which received 30 g of ZJF powder daily alongside a low‐calorie diet, or the control group, which adhered solely to a low‐calorie diet for 12 weeks. The primary outcome was FBG. Secondary outcomes included lipid profile (total cholesterol [TC], triglycerides [TG], low‐density lipoprotein cholesterol [LDL‐C], and high‐density lipoprotein cholesterol [HDL‐C]), liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and gamma‐glutamyl transpeptidase [GGT]), and the severity of hepatic steatosis (assessed via ultrasonography). Measurements were taken at baseline and post‐intervention. After adjusting for baseline values, weight, and waist circumference using ANCOVA, no significant between‐group difference was observed for the primary outcome, FBG ( p  = 0.12). However, the intervention group demonstrated significantly greater reductions in the secondary outcomes of ALT ( p  = 0.015), AST ( p  = 0.001), LDL‐C ( p  = 0.04), TC ( p  = 0.004), and the severity of hepatic steatosis ( p  = 0.001) compared to the control group. No significant between‐group differences were observed for TG, HDL‐C, or GGT. In this randomized controlled trial, daily supplementation with ZJF powder (30 g/day) in conjunction with a low‐calorie diet for 12 weeks did not significantly reduce FBG (the primary outcome) compared to diet alone. However, significant improvements were observed in secondary outcomes, including ALT, AST, TC, LDL‐C, and most notably hepatic steatosis grade. These findings suggest that ZJF may offer metabolic and hepatoprotective benefits in patients with NAFLD, although the primary outcome remained inconclusive. Larger, longer‐term studies with a placebo control are warranted to confirm these effects.

Trial Registration: The protocol of the study was registered at the Iranian Registry of Clinical Trials (IRCT) (IRCT ID: IRCT20140502017522N5; Registration date: June 2023), http://en.irct.ir/trial/69945