{
  "abstract": "Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is closely associated with obesity and insulin resistance. Effective pharmacologic therapies remain limited. Flavonoids, plant-derived polyphenolic compounds with anti-inflammatory, antioxidant, and insulin-sensitizing properties, have been proposed as potential adjunctive therapies for MASLD. This study aimed to evaluate the effects of flavonoid supplementation on hepatic steatosis, liver enzymes, and metabolic parameters in adults with MASLD or non-alcoholic fatty liver disease (NAFLD).Methods A systematic review and meta-analysis of randomized controlled trials was conducted and registered in PROSPERO (CRD420261319744). PubMed and Embase were searched without date or language restrictions. Eligible studies included adults with MASLD or NAFLD receiving purified oral flavonoid supplementation compared with placebo, no treatment, standard care, or lifestyle modification alone. Primary outcomes were hepatic steatosis and alanine aminotransferase (ALT). Secondary outcomes included aspartate aminotransferase (AST), insulin resistance measured by HOMA-IR, and body mass index (BMI). Risk of bias was assessed using the Cochrane RoB-2 tool. Random-effects meta-analysis was performed to pool mean differences (MD) with 95% confidence intervals (CI), and heterogeneity was assessed using the I 2 statistic.Results Nine randomized controlled trials involving 351 participants were included. Five trials reported liver enzyme outcomes. Flavonoid supplementation significantly reduced ALT compared with control (MD −3.97 U/L; 95% CI −6.29 to −1.65; p = 0.0008; I 2 = 0%), with pooled analyses presented in Figure 1 (IDDF2026-ABS-0291 Figure 1. Forest plots of flavonoid supplementation effects on AST, ALT, HOMA-IR and BMI in adults with MASLDNAFLD). No statistically significant reduction was observed for AST (MD −1.89 U/L; 95% CI −4.24 to 0.46; p = 0.12; I2 = 61%). Three trials reported insulin resistance outcomes and demonstrated a significant reduction in HOMA-IR (MD −0.68; 95% CI −1.05 to −0.32; p = 0.0003; I2 = 0%). Body mass index was reported in three trials and showed no significant change (MD −0.47 kg/m2; 95% CI −1.50 to 0.56; p = 0.37; I2 = 0%).Conclusions Flavonoid supplementation may improve hepatocellular injury and insulin resistance in MASLD, as reflected by reductions in ALT and HOMA-IR. However, effects on AST and BMI were not statistically significant. Larger randomized controlled trials are needed to clarify the therapeutic role of flavonoids in MASLD management.Abstract IDDF2026-ABS-0291 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Center of Excellence in Preventive and Integrative Medicine (CE-PIM), Faculty of Medicine, Chulalongkorn University, Thailand"
      ],
      "name": "Natasha Leenabanchong"
    },
    {
      "affiliations": [
        "Center of Excellence in Preventive and Integrative Medicine (CE-PIM), Faculty of Medicine, Chulalongkorn University, Thailand"
      ],
      "name": "Oranut Chatsirisakul"
    },
    {
      "affiliations": [
        "Center of Excellence in Preventive and Integrative Medicine (CE-PIM), Faculty of Medicine, Chulalongkorn University, Thailand"
      ],
      "name": "Krit Pongpirul"
    }
  ],
  "title": "IDDF2026-ABS-0291 Flavonoid supplementation improves liver injury markers and insulin resistance in MASLD: a systematic review and meta-analysis of randomized controlled trials",
  "uid": "959e8473-2436-5bda-a775-98892d1ac5de"
}