Investigation of the Effect of Artichoke ( Cynara Scolymus L . ) on Characteristics of the Fatty Liver

* Corresponding Author: Mohsen Rajabi, MSc. Address: Department of Natural Resources, Agricultural and Natural Resources Research Center, Agricultural Research Education and Extention Organization, Hamedan, Iran. Tel: +98 (918) 3195340 E-mail: m.rajabi@areeo.ac.ir 1. Department of Natural Resources, Agricultural and Natural Resources Research Center, Agricultural Research Education and Extention Organization, Hamedan, Iran. 2. Clinical Research Development Unit of Shahid Beheshti Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. Ramazan Kalvandi1 , *Mohsen Rajabi1 , Zohreh Kahramfar2 , Tahereh Chaleh Cheleh1


Introduction
atty liver is one of the most important causes of chronic liver disease in hu-mans. Non-alcoholic fatty liver disease is a disease that has a wide range of clinical symptoms and, if left untreated, can eventually lead to liver cell cancer and death [1,2]. Many serum enzymes have been suggested for detecting liver cell degradation, of which Aspar-tate Aminotransferase (AST) and Alanine Aminotransferase (ALT) are of particular importance [9].
Therapeutic effects of the artichoke plant (Cynara scolymus L.) include liver supportive, antimicrobial, cholesterol-lowering and lipid-lowering effects, stimulation of nitric oxide synthetase gene expression, and stimulation and improvement of endothelial cells in atherosclerosis healing [16]. In this study, the use of Artichoke as a suitable treatment for fatty liver disease without the mentioned complications was investigated.

Materials and Methods
This study is a randomized non-blind clinical trial based on informed consent and no placebo. The statistical population in this study was the patients referred to Imam Khomeini Hospital in Hamadan. Artichoke plant was prepared from the garden of medicinal plants of Bu-Ali Sina in Hamedan. The parts used in this plant were dried, in the shade, ground, and powdered. Then, the required number was packaged and they were asked to brew and drink a tablespoon of plant leaves with a glass of boiling water twice a day for 20 minutes on indirect heat for 20 minutes, 45 days.
At the end of this study, the results of ultrasound and blood tests of 70 people were finally analyzed. Data collection tools included a questionnaire and ultrasound and personal and demographic information of the samples, condition, and severity of fatty liver and symptoms and comorbidities were completed by the subjects. Finally, the collected data were analyzed by SPSS V. 22 software. Paired t-test was also used to compare the means.

Results
The results showed that the Mean±SD age of the subjects was 47.46±12.10 and patients between the ages of 46-60 had the highest frequency (45.7%) ( Table 1). The Mean±SD of weight and height of the subjects were 76.83±16.70 and 166.56±24.65, respectively. Most of the subjects were female (47=67.1%), with primary literacy (n=28; 40%), and with housekeeping as occupation (n=44; 62.9%) were. The results showed that the Mean±SD of the patients' enzymes measured before and after using the Artichoke plant for ALT enzyme was 52.49±26.76 and 36.96±13.01 (P≤0.005). These values for AST enzyme were: 41.20±14.46 and 31.76±14.46 (P≤0.005), respectively (Table 1).
Based on the results of sonography, 51 patients (72.86%) showed a decrease in the degree or grade of fatty liver (P≤0.01). The mean total grade of fatty liver decreased from 1.67 to 1.0 ( Figure 1). Also, the amount of sugar decreased from 111.58 (before treatment) to 103.58 (after treatment) and cholesterol decreased from 209.28 (before treatment) to 151.23 (after treatment), which as a result of consumption of this plant during 45 days showed a significant decrease (P≤0.045 and P≤0.007, respectively). Triglyceride also decreased from 185.81 to 164.81 which showed no significant changes ( Table 1). The results showed that with increasing the amount of blood cholesterol, the Grade of fatty liver also increased ( Figure 2).

Discussion
The results of the study showed that the drinking of Artichoke tea can be effective in reducing the grade of fatty liver. Many studies have shown that the compounds in plants' extracts can prevent toxic effects on the liver and reduce liver enzymes, which is consistent with the results of the present study.
The prevalence of fatty liver in women (67.1%) in this study was about twice that of men (32.9%). Also, Savadkoohi et al. reported that the rate of fatty liver among women is 3.5 times higher than men, which is consistent with the results of this study [26]. The results also showed that the rate of reduction of the grade of fatty liver and thus improving the effects of fatty liver in women was more than men, which is probably as a result of the subjects' occupation (housewives, 67.3%), who usually on time in drinking herbal tea. According to traditional medicine experts, women are more prone to fatty liver than men due to their cold temper and phlegmatic temperament.
On the other hand, lowering blood sugar, triglyceride, and cholesterol levels showed the positive effects of this plant in reducing and improving liver function and treatment of hyperlipidemia [35]. Studies have shown that this plant reduces lipids and lipoproteins by interfering with the biosynthesis of cholesterol and also affects the production and secretion of bile in the liver. They have also indicated that this plant reduces lipids and lipoproteins by interfering with the biosynthesis of cholesterol and also affects the production and secretion of bile in the liver. It seems that the existence of flavonoid compounds in this plant is responsible for its effects, especially in improving liver's function [40,41].

Conclusion
The results of this clinical trial study showed that it seems that this plant can be used to improve the laboratory symptoms of fatty liver; moreover, can be used as a herbal supplement, with no significant side effects, in reducing the complications of this disease.

Funding
This study did not receive any specific assistance from funding agencies in the public, commercial, or private sectors.