Role of silymarin in the management of non-alcoholic fatty liver disease: Time to clear the mist

Background: Non-alcoholic fatty liver disease (NAFLD) has become a common chronic liver disease, global in nature. Occurring in individuals without a history of significant ethanol consumption, it encompasses a wide spectrum of hepatic disorders. It ranges from simple steatosis, to its advanced form, non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis to even hepatocellular carcinoma. Infact, hepatocellular carcinoma (HCC) can also develop even in the absence of cirrhosis. The prevalence of NAFLD is on the rise primarily because of the already prevalent metabolic conditions like insulin resistance, type 2 diabetes, central obesity and dyslipidemia. Therefore, NAFLD is associated with adverse metabolic consequences. Other than the detrimental hepatic outcomes mentioned above, cases of NAFLD have a very high predisposition to cardiovascular disease. Therefore, management of NAFLD is of paramount importance. However, the challenge lies in the fact that there are no approved therapeutic drug regimens for the treatment of NAFLD. Currently, the standard care comprises of treating the underlying co-existing metabolic abnormalities along with a strong focus on lifestyle modification.Keywords: Non—alcoholic fatty liver disease, antioxidants, milk thistle, silymarin, flavonolignans, silibin