{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:01:44Z","timestamp":1791558104884,"version":"4.3.4"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Non-alcoholic fatty liver disease (NAFLD) is a common health challenge worldwide and urgently requires effective therapeutic interventions. Flavonoids, a diverse group of plant-derived polyphenols, have demonstrated multifaceted biological functions, like anti-inflammatory, antioxidant and metabolic regulatory capacities, suggesting their potential utility in the management of NAFLD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This systematic review and meta-analysis aims to synthesize evidence from randomized controlled trials (RCTs) that examined the effects of flavonoid supplementation (including specific subclasses) in patients with NAFLD on liver function, markers of inflammation, lipid profiles, anthropometric measures and insulin resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study rigorously adhered to the Cochrane Handbook for Systematic Reviews of Interventions (Version 6.5, 2024) and the PRISMA guidelines. A substantial literature review was obtained from PubMed, OVID, Web of Science Core Collection, Embase, and Cochrane Library databases, including studies published through December 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis incorporated 25 RCTs involving 1,689 participants with NAFLD. Flavonoids intervention significantly decreased aspartate aminotransferase (AST), alkaline phosphatase (ALP), alanine aminotransferase (ALT), total cholesterol (TC), steatosis score, body mass index (BMI), triglycerides (TG), fasting blood sugar (FBS), insulin levels and augmented the quantitative insulin sensitivity check index (QUICKI) levels. However, no significant alterations were observed in gamma-glutamyl transferase (GGT), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), body weight (WT), waist-to-height ratio (WHtR), hip circumference (HC), Waist Circumference (WC). Moreover, the impact on hepatic steatosis and fibrosis scores was non-significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Flavonoids exhibit potential therapeutic benefits in mitigating liver enzyme levels, lipid profiles, enhancing insulin sensitivity among NAFLD patients. Nonetheless, their influence on inflammatory markers, and fibrosis scores appears to be limited. Future investigations should focus on assessing the long-term security and effectiveness of flavonoid supplementation in managing NAFLD and exploring their synergistic potential in combination with other therapeutic strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:uri>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251001203<\/jats:uri>.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1660065","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:13:04Z","timestamp":1757909584000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Efficacy of flavonoids in non-alcoholic fatty liver disease: an updated systematic review and meta-analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Qianqian","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haodi","family":"Luan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijiao","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Ai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1097\/hep.0000000000000323","article-title":"AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"E93","DOI":"10.1097\/hep.0000000000000696","article-title":"A multi-society Delphi consensus statement on new fatty liver disease nomenclature","volume":"79","author":"Lazarus","year":"2023","journal-title":"Hepatology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1111\/imj.14709","article-title":"Non-alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management","volume":"50","author":"Huang","year":"2020","journal-title":"Intern Med J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1053\/j.gastro.2020.01.052","article-title":"Nonalcoholic fatty liver disease 2020: the state of the disease","volume":"158","author":"Cotter","year":"2020","journal-title":"Gastroenterology"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000003517","article-title":"Global burden of metabolic-associated fatty liver disease: a systematic analysis of global burden of disease study 2021","author":"Wang","year":"2025","journal-title":"Chin Med J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1097\/hep.0000000000000004","article-title":"The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review","volume":"77","author":"Younossi","year":"2023","journal-title":"Hepatology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1002\/hep.29466","article-title":"Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease","volume":"67","author":"Estes","year":"2018","journal-title":"Hepatology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.metabol.2015.12.012","article-title":"The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD)","volume":"65","author":"Buzzetti","year":"2016","journal-title":"Metabolism"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2250","DOI":"10.3390\/nu15102250","article-title":"Does the Mediterranean diet have any effect on lipid profile, central obesity and liver enzymes in non-alcoholic fatty liver disease (NAFLD) subjects? 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