Effect of Punica granatum Extract Supplementation in Patients With Liver Cirrhosis: A Randomised, Double-Blind, Placebo-Controlled Trial☆

Introduction: Punica granatum is a medicinal plant with health-promoting benefits. This randomised, doubleblind trial aimed to examine the effect of hydro-ethanolic extract of P granatum fruit (PE) in patients with liver cirrhosis.Methods: Here, 99 patients with liver cirrhosis were randomly assigned into two groups to receive PE (20 ml/d) or placebo for 8 weeks. To assess the severity of cirrhosis, the serum concentrations of the alanine and aspartate aminotransferase (ALT and AST), alkaline phosphatase (ALP), total and direct bilirubin (Bil), albumin (Alb), and creatinine (Cr) were measured. The international normalised ratio (INR) and prothrombin time were also measured to calculate the model for end-stage liver disease (MELD) score.Results: We observed a significant difference in the levels of ALT (P = 0.008), ALP (P = 0.001), Bil (direct, P < 0.001), Cr (P = 0.007), INR (P < 0.001), and MELD (P < 0.001) values in the PE group after the 8-week intervention. Furthermore, PE supplementation was associated with improved biochemical parameters, including AST, ALT, ALP, Bil, Alb, Cr, INR, and MELD score compared to the baseline (P = 0.052 for Alb, P < 0.001 for other parameters). Significant changes in AST, ALT, ALP, Bil (total), Cr, INR, and MELD were also found between the two groups after 8-week intervention (P = 0.001 and P = 0.002 for Bil and Cr, respectively; P < 0.001 for other parameters).Conclusions: Our findings suggest the potential benefits of PE supplementation in patients with liver cirrhosis as evidenced by significant improvements in biochemical parameters. However, more clinical studies are still needed for further validation of PE as a therapeutic agent in liver cirrhosis.