Probe • Vol LXII • No. 4 • Sep–Dec 2023 • 21 Safety and Efficacy of Liv.52 DS in the Management of Nonalcoholic Fatty Liver Disease Table 2. The Effect of Liv.52 DS on Hepatomegaly Liver Size on Ultrasonographic Screening Patients, n (%) Baseline Month 1 Month 2 > 16 cm (Hepatomegaly) 45 (75) 43 (72) 25 (42) < 16 cm (No Hepatomegaly) 15 (25) 17 (28) 35 (58) Table 3. Effect of Liv.52 DS on LFTs (AST and ALT) Parameter , IU/L Baseline Month 1 Month 2 AST 60.33 ± 13.04 56.43 ± 15.47 54.12 ± 17.26 P < .0339a ALT 70.68 ± 18.49 64.13 ± 22.07 P < .0215a 61.9 ± 22.7 P < .0022a Statistical test: ANOVA followed by Tukey’s multiple comparison test. Significance was fixed at P < .05. Values are represented as mean ± SD. aCompared with baseline. LFTs, liver function tests; AST, aspartate transaminase; ALT, alanine transaminase. high-density lipoprotein and low-density lipoprotein levels were within the normal range, the total serum cholesterol and serum triglyceride levels were borderline high at screening, and they remained the same at the end of the study. There were no adverse events reported during the entire study period. The overall compliance with the treatment was good, with no treatment discontinuation. Discussion The significant hepatoprotective activity seen in this study can be attributed to the synergistic action of the bioactive herbs present in Liv.52 DS—Capparis spinosa, Cichorium intybus, Solanum nigrum, Terminalia arjuna, Cassia occidentalis, Achillea millefolium, and Tamarix gallica. C spinosa acts against chemically induced hepatotoxicity and prevents elevation of malondialdehyde (plasma and hepatic), AST, and ALT levels. C intybus suppresses the oxidative degradation of DNA in tissue debris. S nigrum protects the DNA against oxidative damage and acts as a potent scavenger of hydroxyl and diphenylpicrylhydrazyl radicals. T arjuna reduces cholesterol levels. C occidentalis modulates hepatic enzyme levels, which provides hepatoprotection. T gallica acts as a hepatic stimulant and has a beneficial effect on liver glycogen and serum proteins. Conclusion The results of this study reveal that after treatment with Liv.52 DS, there was a significant improvement in hepatomegaly and liver function parameters such as AST and ALT. During the study period, there was no progression of liver fibrosis due to NAFLD. Also, no adverse events were reported by the patients. The hematological and biochemical findings of this study suggest that Liv.52 DS is effective and safe in the management of NAFLD. Figure. Effect of Liv.52 DS on Liver Size by Ultrasound Measurement 0.7 0.5 0.2 0.1 0.3 Baseline Month 1 Month 2 0.4 0.6 Hepatomegaly (> 16 cm) No Hepatomegaly (< 16 cm) 0.8 0 Patients, % 0.75 0.72 0.42 0.25 0.28 0.58 < 16 cm). Whereas, after 2 months of treatment with Liv.52 DS, only 42% of patients exhibited hepatomegaly, and 58% of patients showed no hepatomegaly (Table 2). After treatment with Liv.52 DS, the liver size significantly reduced from 17.44 ± 1.9 cm at baseline to 17.29 ± 1.77 cm at the end of 1 month (P < .0001) and further reduced to 15.87 cm at the end of month 2 (Figure). Also, the levels of ALT and AST were elevated at baseline and decreased at the end of the study (Table 3). Hematology and biochemical investigations showed that Liv.52 DS is a safe formulation. Though
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