Role of Arjuna Bark Powder in Fatty Liver Patients: A Prospective, Real-world Study from Bangladesh

Introduction: Fatty liver is a major cause of hepatic fibrosis and all forms of chronic liver disease in Bangladesh as well as globally.To date, lifestyle modification remains the mainstay of fatty liver management.Materials and methods: This is a quasi-experimental study, conducted between July 2023 and June 2024 at the Department of Hepatology, Bangladesh Medical University (BMU), Dhaka, where 60 fatty liver patients were randomized into two groups.Of them, 40 patients were treated with Terminalia arjuna dried bark powder in addition to lifestyle modification, while another 20 patients were advised only lifestyle modification.Patients were treated for 24 weeks and then evaluated.Results: None of the patients included in the study experienced any significant adverse event.All adverse events were mild, not necessitating discontinuation of treatment in any patient.There was significant improvement of clinical and biochemical parameters as well as hepatic fat content and fibrosis following 24 weeks of administration of Terminalia arjuna dried bark powder.Serum alanine transaminase and serum aspartate aminotransferase levels dropped from 59.25 ± 51.14 and 41.05 ± 24.55 U/L to 39.18 ± 22.83 and 30.73 ± 12.01 U/L, respectively.Hepatic fibrosis and fat content also reduced from 6.0 ± 1.54 kPa and 311.85 ± 24.83 dB/m to 5.46 ± 1.35 kPa and 291.0 ± 33.2 dB/m, respectively.However, Terminalia arjuna dried bark powder was not found to be superior to lifestyle modification.Conclusion: This study establishes the safety of Terminalia arjuna in human fatty liver patients.It also resulted in improvement of hepatic steatosis and fibrosis.This signifies the need to conduct multicenter clinical trial with higher doses and longer duration to establish the efficacy of Terminalia arjuna in fatty liver.