Omega-3 / Fish Oil for Masld
Verdict: Published with Warning
Across 5 PubMed studies, the evidence for Omega-3 / Fish Oil in Masld grades Tier C — weak evidence. Effective, but with safety or population caveats.
C 🟠 C Weak Evidence Published with Warning
Why this grade7-layer evidence engine
⚖️
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditableRaw score 0.45
D
C
B
A
S
← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
C · Published with Warning
Confidence
83%
Highly consistent evidence
Evidence level
E2
Multiple high-quality MAs (≥2 independent, consistent)
▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.448
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (4 篇 > 0 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
PubMed studies (5)L2 · primary research & systematic reviews
Omega-3 polyunsaturated fatty acids and nonalcoholic fatty liver disease in adults: A meta-analysis of randomized controlled trials
Finding: Across 20 RCTs (n=1615), omega-3 significantly improved only GGT (WMD -5.38 IU/L, 95% CI -9.16 to -1.61) and ultrasound-assessed steatosis (OR 3.83, 95% CI 1.03 to 14.27), with NO significant effect on AST, ALT, MRS/MRI-PDFF liver fat, stiffness, or histology, and more adverse events in the omega-3 group.
View on PubMed Effects of purified eicosapentaenoic and docosahexaenoic acids in nonalcoholic fatty liver disease: results from the Welcome study
Finding: In the largest double-blind RCT (DHA+EPA n=51 vs placebo n=52, 4 g/day for 15-18 months), the ITT analysis showed only a non-significant trend toward reduced liver fat (beta -3.64%, 95% CI -8.0 to 0.8; p=0.1) and NO improvement in either fibrosis score; benefit appeared only in a secondary per-erythrocyte-DHA-enrichment analysis (beta -1.70 per 1%, p=0.007).
View on PubMed Efficacy of fish oil supplementation on metabolic dysfunction-associated steatotic liver disease: a meta-analysis
Finding: Across 7 RCTs (n=439), fish oil significantly improved triglycerides (SMD -0.40, 95% CI -0.58 to -0.21), AST (SMD -0.29, 95% CI -0.48 to -0.10), HOMA-IR (SMD -2.06, 95% CI -3.36 to -0.49) and waist circumference, but showed NO significant benefit on ALT, GGT, BMI, HDL, LDL or total cholesterol.
View on PubMed Effectiveness of Omega-3 Polyunsaturated Fatty Acids in Non-Alcoholic Fatty Liver Disease: A Meta-Analysis of Randomized Controlled Trials
Finding: Across 7 RCTs (n=442), omega-3 significantly reduced ALT (-7.61, 95% CI -12.83 to -2.39, p=0.004), total cholesterol (-13.41, p=0.001) and triglycerides (-43.96, p<0.00001) and raised HDL-C (+6.97, p=0.006), but effects on AST (p=0.21), GGT (p=0.11) and LDL-C (p=0.05) were only non-significant trends.
View on PubMed Effectiveness of Omega-3 Polyunsaturated Fatty Acids in Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis
Finding: Across 15 studies, omega-3 significantly reduced ALT (MD -2.12, 95% CI -3.36 to -0.87) and AST (MD -1.50, 95% CI -2.59 to -0.42) with GGT only trending (MD -0.82, 95% CI -1.66 to 0.02), but the authors concluded the impact on liver fat content remains uncertain and position omega-3 only as an adjunct.
View on PubMed Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …
L4a US FDA
Supportive
Generally Recognized As Safe (GRAS) - authorized under 21 CFR 184.1472 source↗
L4b EU EFSA
Supportive
intakes of 250mg a day sufficient for normal cardiac function source↗
L4c UK NHS
Neutral
at least 2 portions of fish a week, including 1 of oily fish source↗
L4d TW TFDA / 衛福部
Supportive
每日攝取量所含之ω-3脂肪酸至少應達一．○克 source↗
L4e WHO
Neutral
2 g/day of purified omega-3 fatty acids offer substantial advantages source↗
L5a NIH Office of Dietary Supplements
Supportive
ALA is an essential fatty acid source↗
L5b Mayo Clinic
Cautious
Some research suggests that omega-3 fatty acids may reduce liver fat and may slow or even reverse MASLD scarring. However, other studies haven't found a strong connection between omega-3s and liver inflammation or scarring. Natural sources of omega-3 fatty acids are best. These include fatty fish, such as salmon, mackerel and sardines, walnuts, some seeds, and leafy green vegetables. If you don… source↗
L5c Cleveland Clinic
Cautious
Your provider may recommend meal plans like the Mediterranean diet or the DASH diet. source↗
L5d Harvard Health
Cautious
Mediterranean-style diets can help decrease liver fat, thus helping to prevent or possibly reverse NAFLD. These diets are high in healthful fats, such as monounsaturated fats found in olive oil and avocados, and omega-3 fats found in walnuts and oily fish like salmon and sardines. source↗
L5e Specialty Society (condition-mapped)
Cautious
In adults with MASLD, nutraceuticals cannot be recommended since there is insufficient evidence of their effectiveness in reducing histologically/non-invasively assessed liver damage/fibrosis and liver-related outcomes in MASLD, nor of their safety. source↗