Safety and Efficacy of Moringa oleifera Lam Supplementation in Patients with Metabolic Dysfunction-associated Steatotic Liver Disease: A Prospective Real-world Study from Bangladesh

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern, with limited therapeutic options beyond lifestyle modification.Moringa oleifera Lam, a medicinal plant with reported antioxidant, antiobesity, and hypolipidemic properties, has been proposed as a nutraceutical adjunct. Materials and methods:This randomized, open-label, real-world, prospective study evaluated Moringa oleifera Lam as a safe and efficacious supplementation on clinical, biochemical, and transient elastography-based outcomes in 60 MASLD patients, divided equally into case (group A) and control groups (group B).Again, groups were divided into group AI (case at baseline), group AII (case after intervention for 6 months), group BI (control at baseline), and group BII (control after 6 months).Results: The mean [±standard deviation (SD)] age of cases and controls was 46.48 ± 8.53 years and 42.37 ± 9.05 years.At baseline, cases (A1) and controls (B1) had almost identical body mass index and waist circumference.Glycemic indices, lipid markers, and liver enzymes also showed no significant baseline differences.Liver stiffness measurement (LSM) was 9.1 vs 9.0 kPa; controlled attenuation parameter (CAP) was higher in cases (322.38 ± 33.05) than controls (308.15± 25.44; p = 0.078).After 6 months, cases (A2) showed significant reductions in weight, body mass index, and waist circumference (p < 0.001).Controls (B2) also demonstrated significant declines in body mass index and waist circumference (p < 0.01).Glycated hemoglobin A1c (HbA1c) showed nonsignificant reductions in both groups (cases p = 0.555; controls p = 0.149), while blood sugar, both fasting and 2 hours after breakfast, remained unchanged (p > 0.05).Triglyceride decreased both in cases and controls (195-188 vs 192-160 mg/dL).In cases, low-density lipoprotein (LDL) increased (120.22 ± 35.61 to 133.86 ± 36.32; p = 0.037), while high-density lipoprotein improved modestly (40.82 ± 8.07 to 42.93 ± 7.60; p = 0.152).Triglyceride also rose (201.82 ± 39.03 to 212.37 ± 40.47; p = 0.099).In controls, significant changes occurred in triglycerides or LDL, while high-density lipoprotein increased modestly (40.50 ± 11.99 to 44.88 ± 11.20; p = 0.057).Among liver enzymes, cases showed a slight rise in median of alaline aminotransferase, and an increase in aspartate aminotransferase (33 to 36 U/L), gamma-glutamyl transferase (GGT) (39 to 48 U/L), alkaline phosphatase (ALP) remained unchanged in case group; while controls exhibited significant reductions in alaline aminotransferase (p = 0.006), aspartate aminotransferase (AST) (p = 0.007), GGT (p = 0.044), and nonsignificant reduction in ALP (p = 0.426).Liver stiffness measurement also declined significantly from 9.1 to 7.6 kPa in cases (p = 0.003), and more prominently from 9.0 to 6.4 kPa in controls (p < 0.001).Controlled attenuation parameter values improved significantly in both groups: Cases reduced from 322.38 ± 33.05 to 297.24 ± 35.49 (p = 0.007) and controls from 308.15 ± 25.44 to 284.30 ± 48.25 (p = 0.021).Conclusion: This study concluded that although Moringa oleifera Lam extract therapy is safe, it is not more efficacious than lifestyle modification for hepatic steatosis and fibrosis in patients with MASLD.The study also establishes the potential role of Moringa oleifera Lam as a beneficial nutraceutical in MASLD.The study also reconfirms lifestyle modification as an effective intervention for managing MASLD.