Supplementation with essential phospholipids lowered liver-fat markers in fatty liver disease. Digest
Fatty liver disease linked to metabolic health is increasingly common worldwide, but evidence for approaches that can be added to lifestyle changes to reduce liver fat remains limited. A new study tested whether supplementation with essential phospholipids, molecules that help form the membranes around cells, could lower liver fat markers in people with this condition.
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The trial included 193 adults with metabolic dysfunction-associated steatotic liver disease (MASLD), a condition in which fat builds up in the liver alongside metabolic risk factors such as obesity, high blood sugar, or abnormal cholesterol levels. Participants were randomly assigned to receive 1800 mg per day of soy-derived essential phospholipids or placebo for 6 months. Both groups also received lifestyle guidance focused on diet, avoidance of fructose-rich drinks and foods, alcohol restriction, and exercise, and researchers followed participants for 3 months after treatment ended. The main outcome was an ultrasound-based estimate of fat buildup in the liver at the end of the supplementation period.
- Over six months, the liver fat estimate fell about twice as much with essential phospholipids as with placebo. The difference was already present at three months and remained three months after treatment ended.
- More participants receiving the supplement moved from the highest liver-fat category to lower categories, and a score that is used to flag patients at higher risk of disease progression improved modestly.
- HbA1c, a marker of average blood sugar levels over the previous 2–3 months, started at about 5.8% with essential phospholipids and 5.7% with placebo. Over six months, it fell by about 0.25 percentage points with essential phospholipids and rose by about 0.30 percentage points with placebo.
- Several other measures, including a liver scarring marker, liver enzymes, blood lipids, body weight, and a quality-of-life score did not clearly differ between groups.
- Adverse events occurred at similar rates in both groups. The most common were headache, diarrhea, and cold-like symptoms.
How might essential phospholipids produce these effects? One explanation involves phosphatidylcholine, one of the main components of essential phospholipids. Liver cells use phosphatidylcholine to build and maintain healthy cell membranes and to package fat for transport out of the liver. In MASLD, fat accumulates inside liver cells, and changes in cell membrane composition may impair how those cells function and handle fats. By supplying additional phosphatidylcholine, essential phospholipids may help support the liver's normal fat-handling processes. Although the study did not test this mechanism directly, it provides a biologically plausible explanation for why liver fat markers improved without a clear difference in body weight or changes in body weight between the groups.
The study had industry funding, and some authors had financial ties to or were employees of the funder, so independent confirmation would strengthen confidence. The trial was also too short to assess the effects on long-term complications associated with MASLD. Still, the findings make essential phospholipids an interesting treatment candidate for MASLD patients while keeping lifestyle care and metabolic risk management central. In Q&A #82, I discussed whether increasing choline intake and other lifestyle strategies can help reverse fatty liver disease.