Effect of Black Pepper on Biochemical and FibroScan Parameters in Patients with Grade 2 Non-alcoholic Fatty Liver Disease: A Randomized Controlled Trial

Non-alcoholic fatty liver disease (NAFLD) is increasingly common and has limited approved pharmacologic treatments. Preclinical evidence suggests piperine (black pepper) may improve hepatic steatosis and metabolic parameters. To estimate the efficacy of crushed black pepper (piperine) supplementation on biochemical tests and FibroScan parameters in Grade 2 NAFLD patients. A randomized, double-blind, placebo-controlled trial was performed with 370 patients who were sonographically diagnosed with Grade 2 NAFLD. Participants were randomized 1:1 to receive crushed black pepper (20 mg daily; n = 185) or an identical placebo (n = 185) for 12 weeks. Primary outcomes were changes in liver enzymes (ALT, AST), lipid profile, glycemic indices (FBG, HOMA-IR), and FibroScan measurements (controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]). Biochemical tests and FibroScan were done at baseline and after 12 weeks. Between-group comparisons used unpaired t-tests; within-group changes used paired t-tests. Significance was determined at p