Berberine of little benefit in individuals with obesity and MASLD

Treatment with berberine in diabetes-free individuals with obesity and metabolic dysfunction–associated steatotic liver disease (MASLD) is safe but falls short of reducing visceral adipose tissue (VAT) and liver fat content, as reported in a study.

A total of 337 diabetes-free individuals with obesity and MASLD (mean age 41.8 years, 65.6 percent male) participated in the study. These participants were randomly assigned to receive either berberine at 1 g (n=169) or a matching placebo (n=168), administered orally daily for 6 months.

The primary outcomes of relative percentage change in VAT area and absolute change in liver fat content were evaluated using computed tomography. Other outcomes included changes in parameters of glucose, lipids, and inflammation.

Compared with placebo, berberine had no significant effect on VAT area (difference, 1.4 percent, 97.5 percent confidence interval [CI], −2.4 to 5.2) or liver fat content (difference, 0.9 percent, 97.5 percent CI, −0.4 to 2.1).

Berberine was associated with larger reductions in low-density lipoprotein cholesterol (−7.72 mg/dL, 95 percent CI, −13.13 to −1.93), apolipoprotein B (−3.42 mg/dL, 95 percent CI, −6.33 to −0.51), and high-sensitivity C-reactive protein (−0.072 mg/dL, 95 percent CI, −0.140 to −0.004) relative to placebo.

Adverse events were similar in the two treatment arms.

The mean medication adherence rates were 90.3 percent for berberine and 90.7 percent for placebo.