Efficacy of orlistat in obese patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: Nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant contributor to chronic liver disease worldwide. Orlistat blocks intestinal fat absorption, leading to decreased liver fat content. Therefore, it is a viable option for NAFLD management. Methods: We performed a systematic review and metaanalysis using randomized controlled trials (RCTs). We used mean difference (MD) to pool continuous outcomes presented with the corresponding confidence interval (CI). Results: We included four RCTs with a total of 379 patients. Orlistat was effective in reducing liver fat content (MD: −5.02, 95% CI [–7.23, −2.82], P = 0.00001), alanine transferase (MD: −10.03, 95% CI [–17.80, −2.26], P = 0.01), aspartate transferase (MD: −4.29, 95% CI [–7.59, −0.99], P = 0.01), waist circumference (MD: −3.18, 95% CI [–4.25, −2.10], P = 0.00001), body mass index (MD: −1.03, 95% CI [–1.34, −0.73], P = 0.00001), total cholesterol (MD: −3.75, 95% CI [–4.02, −3.49], P = 0.00001), and low-density lipoprotein (MD: −3.83, 95% CI [–4.05, −3.61], P = 0.00001). However, orlistat was associated with increased serum triglycerides (MD: 7.46, 95% CI [6.48, 8.44], P = 0. 00001). Conclusion: Orlistat is a viable option for NAFLD management; however, it increases triglyceride levels. Larger RCTs are required.