{
  "abstract": "Background/Objectives: Silymarin is a widely used hepatoprotective agent; however, its effects on hepatic steatosis and fibrosis remain unclear. We systematically reviewed the effects of silymarin on liver biochemical parameters, fibrosis, steatosis, and cardiometabolic outcomes, as well as its safety, in chronic liver disease. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to June 11, 2026. Randomized controlled trials (RCTs) and eligible comparative clinical studies that evaluated the use of oral silymarin were included. Risk of bias was evaluated using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Random-effects meta-analyses were performed for alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in placebo-controlled RCTs of silymarin monotherapy and for liver stiffness measurement (LSM) in placebo-controlled RCTs, and the certainty of evidence was assessed using GRADE. Results: Forty-seven studies (37 RCTs and 10 non-randomized studies) met the inclusion criteria. Compared with placebo, silymarin monotherapy significantly reduced ALT (six trials; mean difference [MD], −7.25 IU/L; 95% confidence interval [CI], −11.60 to −2.89) and AST (four trials; MD, −5.36 IU/L; 95% CI, −8.45 to −2.27). In addition, an exploratory meta-analysis of three placebo-controlled RCTs showed a greater reduction in LSM with silymarin-based interventions than with placebo (MD, −0.60 kPa; 95% CI, −1.04 to −0.16). Conclusions: In placebo-controlled trials, silymarin monotherapy significantly reduced serum aminotransferase levels, and an exploratory meta-analysis of three trials also showed a reduction in liver stiffness with silymarin-based interventions. Silymarin was generally well tolerated. Well-designed long-term randomized controlled trials using validated noninvasive or histological fibrosis endpoints are warranted to determine whether these improvements translate into antifibrotic and clinically meaningful benefits.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea",
    "Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea",
    "Institute of Advanced BioConvergence, Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul 04763, Republic of Korea"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hyo Young Lee",
      "orcid": "0000-0001-7993-3572"
    },
    {
      "affs": [
        1
      ],
      "name": "Hyunwoo Oh",
      "orcid": "0000-0003-4224-8808"
    },
    {
      "affs": [
        0
      ],
      "name": "Eileen Laurel Yoon"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Dae Won Jun",
      "orcid": "0000-0002-2875-6139"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ee3hjmbddjgxn.bib",
  "cited_by": 0,
  "doi": "10.3390/nu18213685",
  "fulltext_url": null,
  "id": "ee3hjmbddjgxn",
  "issns": [
    "2072-6643"
  ],
  "landing_url": "https://www.mdpi.com/2072-6643/18/21/3685",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-06",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/ee3hjmbddjgxn.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T00:21:40Z",
      "native_id": "10.3390/nu18213685",
      "source": "crossref",
      "url": "https://www.mdpi.com/2072-6643/18/21/3685"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2072-6643",
      "subfield": "nutrition"
    }
  ],
  "title": "Silymarin-Based Therapies in Chronic Liver Disease: A Systematic Review of Biochemical, Cardiometabolic, Steatosis, and Fibrosis-Related Outcomes",
  "title_text": "Silymarin-Based Therapies in Chronic Liver Disease: A Systematic Review of Biochemical, Cardiometabolic, Steatosis, and Fibrosis-Related Outcomes",
  "type": "peer-reviewed",
  "updated_at": "2026-11-10T00:21:40Z",
  "url": "https://research.draconitic.com/paper/ee3hjmbddjgxn",
  "venue": "Nutrients",
  "versions": []
}