Froylan David Martínez-Sánchez, Sophia Eugenia Martínez-Vázquez, Ricardo Gutiérrez-Monterrubio, Department of Gastroenterology and Hepatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan 14080, CDMX, Mexico
Sergio Muñoz-Martínez, Department of Gastroenterology and Hepatology, ABC Medical Center, Tlalpan 14080, CDMX, Mexico
Ignacio Garcia-Juarez, Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan 14080, CDMX, Mexico
Author contributions: Martínez-Sánchez FD and Garcia-Juarez I conceptualized and designed the commentary; Martínez-Sánchez FD drafted the manuscript; Martínez-Sánchez FD, Martínez-Vázquez SE, Gutiérrez-Monterrubio R and Muñoz-Martínez S conducted the literature review; Garcia-Juarez I provided critical revisions and expert insight on methodology and hepatology context; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no competing interests.
Corresponding author: Ignacio Garcia-Juarez, MD, Professor, Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Av. Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan 14080, CDMX, Mexico. drinter77@gmail.com
Received: May 30, 2025 Revised: June 27, 2025 Accepted: August 1, 2025 Published online: September 27, 2025 Processing time: 118 Days and 14.8 Hours
Abstract
The trial by Cano Contreras et al examined a proprietary formulation containing Silybum marianum and alpha-lipoic acid (SM-ALA), combined with a Mediterranean diet, in patients with metabolic dysfunction-associated steatotic liver disease. While some metabolic benefits were observed, limitations such as the absence of an SM-ALA-only group, the lack of histological data, and a small sample size reduce the validity of the findings. Future research should follow clinical trial standards for pharmacological studies, including phase 1/2 testing, validated outcomes, and transparency.
Core Tip: This commentary reviews a clinical trial that investigated the combination of silymarin and alpha-lipoic acid, along with a Mediterranean diet, in patients with metabolic dysfunction-associated steatotic liver disease. Although some health improvements were noted, issues like small sample size, lack of a supplement-only group, and poor tracking of adherence make the results less reliable. The letter suggests future studies should use stronger designs, clear outcomes, balanced sex representation, and transparent reporting to improve the usefulness and accuracy of research findings.
