Propolis Supplementation in Metabolic Dysfunction‐Associated Steatotic Liver Disease: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Metabolic dysfunction‐associated steatotic liver disease (MASLD) affects 38% of adults globally, with limited pharmacotherapy. Propolis, a bee‐derived compound with diverse biological activities, has emerged as a potential adjunct therapy. This systematic review and meta‐analysis evaluated the effects of propolis supplementation on hepatic steatosis, metabolic parameters, and liver function in adults with MASLD. We searched PubMed, Embase, and Cochrane Library from inception to December 2025 without language or publication‐status restrictions and included randomized controlled trials comparing propolis with placebo or dietary counseling in adults with MASLD or nonalcoholic fatty liver disease (NAFLD). Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane ROB 2.0 tool. Meta‐analyses used random‐effects models. Publication bias was assessed with Doi plots and the Luis Furuya‐Kanamori (LFK) index, and certainty of evidence with the GRADE approach. Four trials ( n = 178) of Iranian poplar‐type propolis were included. Propolis was associated with significant improvement in hepatic steatosis (three trials, n = 156; RR: 2.41; 95% CI: 1.59–3.66; p < 0.001; I 2 = 0%) and modestly reduced fasting glucose (MD: −3.80 mg/dL; p = 0.018). No significant effects were observed on insulin sensitivity indices, lipid profiles, anthropometric measures, or liver enzymes. No publication asymmetry was detected (LFK index = 0.82). Exploratory single‐study CYP2E1 and TRPV4 signals were non‐significant for propolis monotherapy versus control and confounded by exercise co‐intervention. In a small number of short‐term trials, propolis supplementation was associated with improvement in ultrasound‐assessed hepatic steatosis, with low heterogeneity. However, limited trials, small samples, restriction to Iranian propolis, absence of histological endpoints, and single‐study mechanistic findings position this as hypothesis‐generating research. GRADE certainty was very low to low, underscoring the need for larger, well‐designed trials.