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The effect of metformin on aminotransferase levels, metabolic parameters and body mass index in nonalcoholic fatty liver disease patients: a meta-analysis.

BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is one of the most common reasons for the increase in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Moreover, liver-associated death is approximately 10 times higher in patients with NAFLD than in common individuals. In theory, NAFLD is a kind of metabolic syndrome that manifests in the liver, and insulin resistance plays an important role. Therefore, drugs that improve insulin sensitivity may be effective for NAFLD.


OBJECTIVE
To evaluate the effect of metformin treatment on aminotransferase levels, metabolic parameters and body mass index in NAFLD patients via a meta-analysis of clinical trials.


METHODS
A comprehensive search of PubMed, EMBASE, the Web of Science and the Cochrane Central Register of Controlled Trials was performed for randomized controlled trials(RCTs) on the effect of metformin treatment on aminotransferase levels, metabolic parameters and body mass index in NAFLD patients. Serum hepatic enzyme, lipid, glucose and insulin levels, homeostasis model assessment-insulin resistance (HOMA-IR) index and body mass index (BMI) at different follow-up points were desirable outcomes. The final search was performed in January, 2021.


RESULTS
In total, 10 RCTs with 459 patients were included. Compared with controls, metformin can effectively reduce serum fasting glucose and insulin levels and the HOMA-IR index in NAFLD patients at the 6-month follow-up. In addition, metformin can clearly reduce the serum ALT and HOMA-IR index at the 12-month follow-up. Although metformin is effective in managing lipid metabolism and controlling BMI in NAFLD patients compared with that at baseline, the effect was similar to that in controls. In addition, the speed of metformin treatment seems to be slower than that of controls.


CONCLUSION
Compared to the controls, metformin can effectively reduce the serum fasting glucose and insulin levels and the HOMA-IR index in NAFLD patients at the 6-month follow-up and ALT and the HOMA-IR index at the 12-month follow-up.