The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding) and by inconsistency.
A Cochrane review [Abstract] 1 included 20 RCTs with a total of 1225 subjects to assess the benefits and harms of antioxidant supplements for patients with liver diseases. Randomized trials that compared antioxidant supplements (beta-carotene, vitamin A, C, E, and selenium) versus placebo or no intervention for autoimmune liver diseases, viral hepatitis, alcoholic liver disease, and cirrhosis (any aetiology) were included.
The majority of the trials had high risk of bias. The assessed antioxidant supplements had no significant effect on all-cause mortality (RR 0.84, 95% CI 0.60 to 1.19), or liver-related mortality (RR 0.89, 95% CI 0.39 to 2.05, I2 = 37%). No reduction in mortality was observed in studies with the smallest risk of bias. Stratification according to the type of liver disease did not affect noticeably the results. Antioxidant supplements significantly increased activity of gamma glutamyl transpeptidase (MD 24.21 IU/l, 95% CI 6.67 to 41.75).
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