medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-216medsovet-10206Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERЭссенциальные фосфолипиды в терапии метаболически ассоциированной жировой болезни печени: от молекулярных механизмов к клинической эффективности (обзор литературы)Essential phospholipids in the treatment of metabolic dysfunction-associated steatotic liver disease: From molecular mechanisms to clinical efficacy (a literature review)https://orcid.org/0000-0003-4294-5531ОковитыйС. В.OkovityiS. V.

Оковитый Сергей Владимирович - д.м.н., профессор, заведующий кафедрой фармакологии и клинической фармакологии, Санкт-Петербургский ГЧФУ; профессор Научно-клинического и образовательного центра гастроэнтерологии и гепатологии, Санкт-Петербургский ГУ.

197022, Санкт-Петербург, ул. Профессора Попова, д. 14, лит. А; 199034, Санкт-Петербург, Университетская наб., д. 7–9

Sergey V. Okovityi - Dr. Sci. (Med.), Professor, Head of the Department of Pharmacology and Clinical Pharmacology, Saint Petersburg SCPU; Professor of the Scientific, Clinical and Educational Center for Gastroenterology and Hepatology, St Petersburg S.U.

14А, Professor Popov St., St Petersburg, 197022; 7–9, Universitetskaya Emb., St Petersburg, 199034

okovityy@mail.ruhttps://orcid.org/0000-0001-8913-140XМаевскаяМ. В.MaevskayaM. V.

Маевская Марина Викторовна - д.м.н., профессор, консультант лечебно-диагностического отделения №3 Университетской клинической больницы №2.

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Marina V. Maevskaya - Dr. Sci. (Med.), Professor, Medical Adviser of the Diagnostic and Treatment Department No. 3, University Clinical Hospital No. 2.

8, Bldg. 2, Trubetskaya St., Moscow, 119048

maevskaya_m_v@staff.sechenov.ruhttps://orcid.org/0000-0002-4690-1811ПриходькоВ. А.PrikhodkoV. A.

Приходько Вероника Александровна - к.б.н., доцент кафедры фармакологии и клинической фармакологии.

197022, Санкт-Петербург, ул. Профессора Попова, д. 14, лит. А

Veronika A. Prikhodko - Cand. Sci. (Biol.), Associate Professor of the Department of Pharmacology and Clinical Pharmacology.

14А, Professor Popov St., St Petersburg, 197022

vaprikhodko@mail.ruСанкт-Петербургский государственный химико-фармацевтический университет; Санкт-Петербургский государственный университетРоссияSaint Petersburg State Chemical and Pharmaceutical University; St Petersburg State UniversityRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationСанкт-Петербургский государственный химико-фармацевтический университетРоссияSaint Petersburg State Chemical and Pharmaceutical UniversityRussian Federation202601072026088292Copyright © Оковитый С.В., Маевская М.В., Приходько В.А., 20262026Оковитый С.В., Маевская М.В., Приходько В.А.Okovityi S.V., Maevskaya M.V., Prikhodko V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10206

Метаболически ассоциированная жировая болезнь печени (МАЖБП) является зонтичным понятием, охватывающим спектр состояний от стеатоза до метаболически ассоциированного стеатогепатита (МАСГ), фиброза и цирроза печени, связанных с системной метаболической дисфункцией. МАЖБП демонстрирует неуклонный рост распространенности и имеет тесную взаимосвязь с сердечно-сосудистой заболеваемостью и смертностью, что делает ее одним из наиболее актуальных хронических неинфекционных заболеваний. В настоящем обзоре проанализированы данные клинических исследований (КИ), посвященных эффективности применения эссенциальных фосфолипидов (ЭФЛ) в качестве средства монотерапии и адъювантной терапии МАЖБП с учетом особенностей их механизмов действия, эффектов и потенциала фармакологического энхансинга. Обзор выполнен в нарративном (несистематическом) формате на основании поиска источников, проведенного в российских и международных специализированных базах данных и регистрах КИ. ЭФЛ и их основной активный компонент – 1,2-дилинолеоилфосфатидилхолин – повышают стабильность и текучесть клеточных мембран, поддерживают трансмембранные процессы, уменьшают выраженность митохондриальной дисфункции и оксидативного стресса, ингибируют липогенез, облегчают эффлюкс желчных кислот, замедляют активацию звездчатых клеток печени, уменьшают локальное воспаление и апоптоз гепатоцитов. Помимо собственной гепатотропной активности, ЭФЛ способны выступать в роли фармакологического энхансера, повышая биодоступность, пролонгируя системную циркуляцию и усиливая эффекты других лекарственных соединений. При использовании в качестве средства монотерапии МАЖБП/МАСГ ЭФЛ оказывают антицитолитический эффект, могут уменьшать стеатоз печени (по данным ультрасонографии) и улучшать показатели липидного спектра, однако имеющиеся доказательства ограничены малой мощностью и погрешностями дизайна КИ. Наибольший интерес представляют возможности применения ЭФЛ в рамках комплексной фармакотерапии МАЖБП у коморбидных пациентов. В КИ подтверждено, что включение ЭФЛ в схемы базисной терапии позволяет повысить ее эффективность в отношении морфологических изменений в печени, маркерных ферментов, показателей липидного обмена, а также качества жизни пациентов.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an umbrella term encompassing a spectrum of conditions ranging from steatosis to metabolic dysfunction-associated steatohepatitis (MASH), liver fibrosis, and cirrhosis associated with systemic metabolic dysfunction. The prevalence of MASLD continues to rise steadily and is closely linked to cardiovascular morbidity and mortality, making it one of the most relevant chronic noncommunicable diseases. This review analyzes data from clinical trials on the efficacy of essential phospholipids (EPL) as monoand adjuvant therapy for MASLD, taking into account the characteristics of their mechanisms of action, effects, and potential for pharmacological enhancement. The review was conducted using a narrative (non-systematic) approach based on a literature search performed in Russian and international specialized databases and clinical trial registries. EPL and their principal active component, 1,2-dilinoleoylphosphatidylcholine, enhance the stability and fluidity of cell membranes, support the transmembrane processes, reduce the severity of mitochondrial dysfunction and oxidative stress, inhibit lipogenesis, facilitate bile acid efflux, slow the activation of hepatic stellate cells, and reduce local inflammation and hepatocyte apoptosis. In addition to their own hepatotropic activity, EPL may also act as a pharmacological enhancer by increasing bioavailability, prolonging systemic circulation, and potentiating the effects of other drugs. When used as monotherapy for MASLD/MASH, EPL exert an anti-cytolytic effect, may reduce hepatic steatosis (assessed by ultrasonography), and improve lipid profile parameters; however, the available evidence is limited by the small statistical power and design flaws of the clinical trials. Special attention has been directed toward the potential use of EPL as part of combination pharmacotherapy for MASLD in comorbid patients. As evidenced by clinical trials, the addition of EPL to standard treatment regimens can enhance therapeutic efficacy regarding morphological liver changes, marker enzyme levels, lipid metabolism parameters, and patients’ quality of life.

фосфолипидыфосфатидилхолиннеалкогольная жировая болезнь печениметаболически ассоциированная жировая болезнь печенигепатотропные средствакомбинированная фармакотерапияphospholipidsphosphatidylcholinenonalcoholic fatty liver diseasemetabolic dysfunction-associated steatotic liver diseasehepatotropic agentscombination pharmacotherapyReferencesRinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542–1556. https://doi.org/10.1016/j.jhep.2023.06.003.Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542–1556. https://doi.org/10.1016/j.jhep.2023.06.003.Райхельсон КЛ, Маевская МВ, Жаркова МС, Гречишникова ВР, Оковитый СВ, Деева ТА и др. Жировая болезнь печени: новая номенклатура и ее адаптация в Российской Федерации. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2024;34(2):35–44. https://doi.org/10.22416/1382-4376-2024-961.Raikhelson KL, Maevskaya MV, Zharkova MS, Grechishnikova VR, Okovityi SV, Deeva TA et al. Steatotic Liver Disease: New Nomenclature and Its Localization in the Russian Federation. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024;34(2):35–44. (In Russ.) https://doi.org/10.22416/1382-4376-2024-961.Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335–1347. https://doi.org/10.1097/HEP.0000000000000004.Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335–1347. https://doi.org/10.1097/HEP.0000000000000004.Драпкина ОМ, Евстифеева СЕ, Шальнова СА, Куценко ВА, Баланова ЮА, Имаева АЭ и др. Распространенность неалкогольной жировой болезни печени и ее ассоциации с сердечно-сосудистыми факторами риска (данные российских эпидемиологических исследований). Кардио­ васкулярная терапия и профилактика. 2025;24(2):4316. https://doi.org/10.15829/1728-8800-2025-4316.Drapkina OM, Evstifeeva SE, Shalnova SA, Kutsenko VA, Balanova YuA, Imaeva AE et al. Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular risk factors (data from Russian epidemiological studies). Cardiovascular Therapy and Prevention. 2025;24(2):4316. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4316.Le MH, Yeo YH, Zou B, Barnet S, Henry L, Cheung R, Nguyen MH. Forecasted 2040 global prevalence of nonalcoholic fatty liver disease using hierarchical bayesian approach. Clin Mol Hepatol. 2022;28(4):841–850. https://doi.org/10.3350/cmh.2022.0239.Le MH, Yeo YH, Zou B, Barnet S, Henry L, Cheung R, Nguyen MH. Forecasted 2040 global prevalence of nonalcoholic fatty liver disease using hierarchical bayesian approach. Clin Mol Hepatol. 2022;28(4):841–850. https://doi.org/10.3350/cmh.2022.0239.Tacke F, Horn P, Wong VWS, Ratziu V, Bugianesi E, Francque S et al. EASLEASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492–542. https://doi.org/10.1016/j.jhep.2024.04.031.Tacke F, Horn P, Wong VWS, Ratziu V, Bugianesi E, Francque S et al. EASLEASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492–542. https://doi.org/10.1016/j.jhep.2024.04.031.Ивашкин ВТ, Драпкина ОМ, Маевская МВ, Райхельсон КЛ, Оковитый СВ, Жаркова МС и др. Клинические рекомендации Российского общества по изучению печени, Российской гастроэнтерологической ассоциации, Российского общества профилактики неинфекционных заболеваний, Российской ассоциации эндокринологов, Российского научного медицинского общества терапевтов, Национального общества профилактической кардиологии, Российской ассоциации геронтологов и гериатров по неалкогольной жировой болезни печени. Российский журнал гастро­ энтерологии, гепатологии, колопроктологии. 2025;35(1):94–152. https://doi.org/10.22416/1382-4376-2025-35-1-94-152.Ivashkin VT, Drapkina OM, Maevskaya MV, Raikhelson KL, Okovityi SV, Zharkova MS et al. Clinical Guidelines of the Russian Society for the Study of the Liver, Russian Gastroenterological Association, Russian Society for the Prevention of Non-Communicable Diseases, Russian Association of Endocrinologists, Russian Scientific Medical Society of Therapists, National Society of Preventive Cardiology, Russian Association of Gerontologists and Geriatricians on Non-Alcoholic Fatty Liver Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2025;35(1):94–152. https://doi.org/10.22416/1382-4376-2025-35-1-94-152.Шляхто ЕВ, Недогода СВ, Бабенко АЮ, Арутюнов ГП, Драпкина ОМ, Кобалава ЖД и др. Концепция междисциплинарного согласительного документа по кардио-рено-гепато-метаболическому синдрому. Российский кардиологический журнал. 2025;30(1S):6533. https://doi.org/10.15829/15604071-2025-6533.Shlyakhto EV, Nedogoda SV, Babenko AYu, Arutyunov GP, Drapkina OM, Kobalava ZhD et al. Concept of an interdisciplinary consensus document on cardiovascular-renal-hepatic-metabolic syndrome. Russian Journal of Cardiology. 2025;30(1S):6533. (In Russ.) https://doi.org/10.15829/15604071-2025-6533.Gundermann KJ, Kuenker A, Kuntz E, Droździk M. Activity of essential phospholipids (EPL) from soybean in liver diseases. Pharmacol Rep. 2011;63(3):643–659. https://doi.org/10.1016/s1734-1140(11)70576-x.Gundermann KJ, Kuenker A, Kuntz E, Droździk M. Activity of essential phospholipids (EPL) from soybean in liver diseases. Pharmacol Rep. 2011;63(3):643–659. https://doi.org/10.1016/s1734-1140(11)70576-x.Gundermann KJ, Gundermann S, Drozdzik M, Mohan Prasad VG. Essential phospholipids in fatty liver: a scientific update. Clin Exp Gastroenterol. 2016;9:105–117. https://doi.org/10.2147/CEG.S96362.Gundermann KJ, Gundermann S, Drozdzik M, Mohan Prasad VG. Essential phospholipids in fatty liver: a scientific update. Clin Exp Gastroenterol. 2016;9:105–117. https://doi.org/10.2147/CEG.S96362.LeKim D, Betzing H, Stoffel W. Incorporation of complete phospholipid molecules in cellular membranes of rat liver after uptake from blood serum. Hoppe Seylers Z Physiol Chem. 1972;353(6):949–964. https://doi.org/10.1515/bchm2.1972.353.1.949.LeKim D, Betzing H, Stoffel W. Incorporation of complete phospholipid molecules in cellular membranes of rat liver after uptake from blood serum. Hoppe Seylers Z Physiol Chem. 1972;353(6):949–964. https://doi.org/10.1515/bchm2.1972.353.1.949.Lieber CS, Robins SJ, Li J, DeCarli LM, Mak KM, Fasulo JM, Leo MA. Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon. Gastroenterology. 1994;106(1):152–159. https://doi.org/10.1016/s0016-5085(94)95023-7.Lieber CS, Robins SJ, Li J, DeCarli LM, Mak KM, Fasulo JM, Leo MA. Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon. Gastroenterology. 1994;106(1):152–159. https://doi.org/10.1016/s0016-5085(94)95023-7.Oette K, Kühn G, Römer A, Niemann R, Gundermann KJ, Schumacher R. Absorption of di-linoleoylphosphatidylcholine after oral administration. Arzneimittelforschung. 1995;45(8):875–879. Available at: https://pubmed.ncbi.nlm.nih.gov/7575751/.Oette K, Kühn G, Römer A, Niemann R, Gundermann KJ, Schumacher R. Absorption of di-linoleoylphosphatidylcholine after oral administration. Arzneimittelforschung. 1995;45(8):875–879. Available at: https://pubmed.ncbi.nlm.nih.gov/7575751/.Waskell L, Koblin D, Canova-Davis E. The lipid composition of human liver microsomes. Lipids. 1982;17(4):317–320. https://doi.org/10.1007/BF02534948.Waskell L, Koblin D, Canova-Davis E. The lipid composition of human liver microsomes. Lipids. 1982;17(4):317–320. https://doi.org/10.1007/BF02534948.van der Veen JN, Kennelly JP, Wan S, Vance JE, Vance DE, Jacobs RL. The critical role of phosphatidylcholine and phosphatidylethanolamine metabolism in health and disease. Biochim Biophys Acta Biomembr. 2017;1859(9 Pt B): 1558–1572. https://doi.org/10.1016/j.bbamem.2017.04.006.van der Veen JN, Kennelly JP, Wan S, Vance JE, Vance DE, Jacobs RL. The critical role of phosphatidylcholine and phosphatidylethanolamine metabolism in health and disease. Biochim Biophys Acta Biomembr. 2017;1859(9 Pt B): 1558–1572. https://doi.org/10.1016/j.bbamem.2017.04.006.Li Z, Agellon LB, Allen TM, Umeda M, Jewell L, Mason A, Vance DE. The ratio of phosphatidylcholine to phosphatidylethanolamine influences membrane integrity and steatohepatitis. Cell Metab. 2006;3(5):321–331. https://doi.org/10.1016/j.cmet.2006.03.007.Li Z, Agellon LB, Allen TM, Umeda M, Jewell L, Mason A, Vance DE. The ratio of phosphatidylcholine to phosphatidylethanolamine influences membrane integrity and steatohepatitis. Cell Metab. 2006;3(5):321–331. https://doi.org/10.1016/j.cmet.2006.03.007.Puri P, Baillie RA, Wiest MM, Mirshahi F, Choudhury J, Cheung O et al. A lipidomic analysis of nonalcoholic fatty liver disease. Hepatology. 2007;46(4):1081–1090. https://doi.org/10.1002/hep.21763.Puri P, Baillie RA, Wiest MM, Mirshahi F, Choudhury J, Cheung O et al. A lipidomic analysis of nonalcoholic fatty liver disease. Hepatology. 2007;46(4):1081–1090. https://doi.org/10.1002/hep.21763.Fu S, Yang L, Li P, Hofmann O, Dicker L, Hide W et al. Aberrant lipid metabolism disrupts calcium homeostasis causing liver endoplasmic reticulum stress in obesity. Nature. 2011;473(7348):528–531. https://doi.org/10.1038/nature09968.Fu S, Yang L, Li P, Hofmann O, Dicker L, Hide W et al. Aberrant lipid metabolism disrupts calcium homeostasis causing liver endoplasmic reticulum stress in obesity. Nature. 2011;473(7348):528–531. https://doi.org/10.1038/nature09968.Shama S, Jang H, Wang X, Zhang Y, Shahin NN, Motawi TK et al. Phosphatidylethanolamines Are Associated with Nonalcoholic Fatty Liver Disease (NAFLD) in Obese Adults and Induce Liver Cell Metabolic Perturbations and Hepatic Stellate Cell Activation. Int J Mol Sci. 2023;24(2):1034. https://doi.org/10.3390/ijms24021034.Shama S, Jang H, Wang X, Zhang Y, Shahin NN, Motawi TK et al. Phosphati- dylethanolamines Are Associated with Nonalcoholic Fatty Liver Disease (NAFLD) in Obese Adults and Induce Liver Cell Metabolic Perturbations and Hepatic Stellate Cell Activation. Int J Mol Sci. 2023;24(2):1034. https://doi.org/10.3390/ijms24021034.Arendt BM, Ma DW, Simons B, Noureldin SA, Therapondos G, Guindi M et al. Nonalcoholic fatty liver disease is associated with lower hepatic and erythrocyte ratios of phosphatidylcholine to phosphatidylethanolamine. Appl Physiol Nutr Metab. 2013;38(3):334–340. https://doi.org/10.1139/apnm-2012-0261.Arendt BM, Ma DW, Simons B, Noureldin SA, Therapondos G, Guindi M et al. Nonalcoholic fatty liver disease is associated with lower hepatic and erythrocyte ratios of phosphatidylcholine to phosphatidylethanolamine. Appl Physiol Nutr Metab. 2013;38(3):334–340. https://doi.org/10.1139/apnm-2012-0261.Peng KY, Watt MJ, Rensen S, Greve JW, Huynh K, Jayawardana KS et al. Mitochondrial dysfunction-related lipid changes occur in nonalcoholic fatty liver disease progression. J Lipid Res. 2018;59(10):1977–1986. https://doi.org/10.1194/jlr.M085613.Peng KY, Watt MJ, Rensen S, Greve JW, Huynh K, Jayawardana KS et al. Mitochondrial dysfunction-related lipid changes occur in nonalcoholic fatty liver disease progression. J Lipid Res. 2018;59(10):1977–1986. https://doi.org/10.1194/jlr.M085613.Piras IS, Raju A, Don J, Schork NJ, Gerhard GS, DiStefano JK. Hepatic PEMT Expression Decreases with Increasing NAFLD Severity. Int J Mol Sci. 2022;23(16):9296. https://doi.org/10.3390/ijms23169296.Piras IS, Raju A, Don J, Schork NJ, Gerhard GS, DiStefano JK. Hepatic PEMT Expression Decreases with Increasing NAFLD Severity. Int J Mol Sci. 2022;23(16):9296. https://doi.org/10.3390/ijms23169296.Wupperfeld D, Fricker G, Bois De Fer B, Frank L, Wehrle A, Popovic B. Essential phospholipids decrease apoptosis and increase membrane transport in human hepatocyte cell lines. Lipids Health Dis. 2022;21(1):91. https://doi.org/10.1186/s12944-022-01698-8.Wupperfeld D, Fricker G, Bois De Fer B, Frank L, Wehrle A, Popovic B. Essential phospholipids decrease apoptosis and increase membrane transport in human hepatocyte cell lines. Lipids Health Dis. 2022;21(1):91. https://doi.org/10.1186/s12944-022-01698-8.Notarnicola M, Caruso MG, Tutino V, Bonfiglio C, Cozzolongo R, Giannuzzi V et al. Significant decrease of saturation index in erythrocytes membrane from subjects with non-alcoholic fatty liver disease (NAFLD). Lipids Health Dis. 2017;16(1):160. https://doi.org/10.1186/s12944-017-0552-0.Notarnicola M, Caruso MG, Tutino V, Bonfiglio C, Cozzolongo R, Giannuzzi V et al. Significant decrease of saturation index in erythrocytes membrane from subjects with non-alcoholic fatty liver disease (NAFLD). Lipids Health Dis. 2017;16(1):160. https://doi.org/10.1186/s12944-017-0552-0.Min JY, Kim DH. Stearoyl-CoA Desaturase 1 as a Therapeutic Biomarker: Focusing on Cancer Stem Cells. Int J Mol Sci. 2023;24(10):8951. https://doi.org/10.3390/ijms24108951.Min JY, Kim DH. Stearoyl-CoA Desaturase 1 as a Therapeutic Biomarker: Focusing on Cancer Stem Cells. Int J Mol Sci. 2023;24(10):8951. https://doi.org/10.3390/ijms24108951.Hegazy MA, Ahmed SM, Sultan SM, Afifi OF, Mohamed MA, Azab AE et al. Metabolic dysfunction-associated steatotic liver disease and omega-6 polyunsaturated fatty acids: Friends or foes. World J Hepatol. 2025;17(3):102286. https://doi.org/10.4254/wjh.v17.i3.102286.Hegazy MA, Ahmed SM, Sultan SM, Afifi OF, Mohamed MA, Azab AE et al. Metabolic dysfunction-associated steatotic liver disease and omega-6 polyunsaturated fatty acids: Friends or foes. World J Hepatol. 2025;17(3):102286. https://doi.org/10.4254/wjh.v17.i3.102286.Liu Z, Wang P, Wang Y, Yu J, Wang Q, Li J, Shi D. Association of circulating fatty acids with metabolic dysfunction-associated steatotic liver disease: A cross-sectional analysis and Mendelian randomization study. Clin Nutr ESPEN. 2025;69:294–302. https://doi.org/10.1016/j.clnesp.2025.07.027.Liu Z, Wang P, Wang Y, Yu J, Wang Q, Li J, Shi D. Association of circulating fatty acids with metabolic dysfunction-associated steatotic liver disease: A cross-sectional analysis and Mendelian randomization study. Clin Nutr ESPEN. 2025;69:294–302. https://doi.org/10.1016/j.clnesp.2025.07.027.Palomurto S, Virtanen KA, Kärjä V, Schwab U, Kaminska D, Käkelä P et al. Metabolic Dysfunction-associated Steatotic Liver Disease Alters Fatty Acid Profiles in the Liver and Adipose Tissue. J Clin Endocrinol Metab. 2025;111(1):e23–e31. https://doi.org/10.1210/clinem/dgaf346.Palomurto S, Virtanen KA, Kärjä V, Schwab U, Kaminska D, Käkelä P et al. Metabolic Dysfunction-associated Steatotic Liver Disease Alters Fatty Acid Profiles in the Liver and Adipose Tissue. J Clin Endocrinol Metab. 2025;111(1):e23–e31. https://doi.org/10.1210/clinem/dgaf346.Dajani AI, Popovic B. Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis. World J Clin Cases. 2020;8(21):5235–5249. https://doi.org/10.12998/wjcc.v8.i21.5235.Dajani AI, Popovic B. Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis. World J Clin Cases. 2020;8(21):5235–5249. https://doi.org/10.12998/wjcc.v8.i21.5235.Han C, Gu Y, Miao R, Han W, Zhang Q, Hu X et al. DLPC induces ferroptosis in cancer cells. Acta Biochim Biophys Sin. 2024;56(9):1401–1405. https://doi.org/10.3724/abbs.2024097.Han C, Gu Y, Miao R, Han W, Zhang Q, Hu X et al. DLPC induces ferroptosis in cancer cells. Acta Biochim Biophys Sin. 2024;56(9):1401–1405. https://doi.org/10.3724/abbs.2024097.Aleynik SI, Leo MA, Takeshige U, Aleynik MK, Lieber CS. Dilinoleoylphosphatidylcholine is the active antioxidant of polyenylphosphatidylcholine. J Investig Med. 1999;47(9):507–512. Available at: https://pubmed.ncbi.nlm.nih.gov/10572382/.Aleynik SI, Leo MA, Takeshige U, Aleynik MK, Lieber CS. Dilinoleoylphosphatidylcholine is the active antioxidant of polyenylphosphatidylcholine. J Investig Med. 1999;47(9):507–512. Available at: https://pubmed.ncbi. nlm.nih.gov/10572382/.Kim ST, Chung YH, Lee HS, Chung SJ, Lee JH, Sohn UD et al. Protective effects of phosphatidylcholine on oxaliplatin-induced neuropathy in rats. Life Sci. 2015;130:81–87. https://doi.org/10.1016/j.lfs.2015.03.013.Kim ST, Chung YH, Lee HS, Chung SJ, Lee JH, Sohn UD et al. Protective effects of phosphatidylcholine on oxaliplatin-induced neuropathy in rats. Life Sci. 2015;130:81–87. https://doi.org/10.1016/j.lfs.2015.03.013.Lin Z, Wang X, Bu X, Huang Q, Wang H, Li E et al. Effects of Dietary Phosphatidylcholine Supplementation on Growth Performance, Antioxidant Capacity, Fatty Acid Composition, and Lipid Metabolism of Juvenile Eriocheir sinensis-Fed Different Oil Sources. Aquac Nutr. 2025;2025:5627355. https://doi.org/10.1155/anu/5627355.Lin Z, Wang X, Bu X, Huang Q, Wang H, Li E et al. Effects of Dietary Phosphatidylcholine Supplementation on Growth Performance, Antioxidant Capacity, Fatty Acid Composition, and Lipid Metabolism of Juvenile Eriocheir sinensis-Fed Different Oil Sources. Aquac Nutr. 2025;2025:5627355. https://doi.org/10.1155/anu/5627355.Son Y, Lee JH, Kim NH, Surh NY, Kim EC, Chung HT et al. Dilinoleoylphosphatidylcholine induces the expression of the antiinflammatory heme oxygenase-1 in RAW264.7 macrophages. Biofactors. 2010;36(3):210–215. https://doi.org/10.1002/biof.87.Son Y, Lee JH, Kim NH, Surh NY, Kim EC, Chung HT et al. Dilinoleoylphosphatidylcholine induces the expression of the antiinflammatory heme oxygenase-1 in RAW264.7 macrophages. Biofactors. 2010;36(3):210–215. https://doi.org/10.1002/biof.87.Kim SH, Kim BK, Park S, Park SK. Phosphatidylcholine Extends Lifespan via DAF-16 and Reduces Amyloid-Beta-Induced Toxicity in Caenorhabditis ele­ gans. Oxid Med Cell Longev. 2019;2019:2860642. https://doi.org/10.1155/2019/2860642.Kim SH, Kim BK, Park S, Park SK. Phosphatidylcholine Extends Lifespan via DAF-16 and Reduces Amyloid-Beta-Induced Toxicity in Caenorhabditis ele­ gans. Oxid Med Cell Longev. 2019;2019:2860642. https://doi.org/10.1155/2019/2860642.Li Volti G, Sorrenti V, Murabito P, Galvano F, Veroux M, Gullo A et al. Pharmacological induction of heme oxygenase-1 inhibits iNOS and oxidative stress in renal ischemia-reperfusion injury. Transplant Proc. 2007;39(10):2986–2991. https://doi.org/10.1016/j.transproceed.2007.09.047.Li Volti G, Sorrenti V, Murabito P, Galvano F, Veroux M, Gullo A et al. Pharmacological induction of heme oxygenase-1 inhibits iNOS and oxidative stress in renal ischemia-reperfusion injury. Transplant Proc. 2007;39(10):2986–2991. https://doi.org/10.1016/j.transproceed.2007.09.047.Bochkov V, Gesslbauer B, Mauerhofer C, Philippova M, Erne P, Oskolkova OV. Pleiotropic effects of oxidized phospholipids. Free Radic Biol Med. 2017;111:6–24. https://doi.org/10.1016/j.freeradbiomed.2016.12.034.Bochkov V, Gesslbauer B, Mauerhofer C, Philippova M, Erne P, Oskolkova OV. Pleiotropic effects of oxidized phospholipids. Free Radic Biol Med. 2017;111:6–24. https://doi.org/10.1016/j.freeradbiomed.2016.12.034.Mattson MP. Roles of the lipid peroxidation product 4-hydroxynonenal in obesity, the metabolic syndrome, and associated vascular and neurodegenerative disorders. Exp Gerontol. 2009;44(10):625–633. https://doi.org/10.1016/j.exger.2009.07.003.Mattson MP. Roles of the lipid peroxidation product 4-hydroxynonenal in obesity, the metabolic syndrome, and associated vascular and neurodegenerative disorders. Exp Gerontol. 2009;44(10):625–633. https://doi.org/10.1016/j.exger.2009.07.003.Al-Orf SM. Effect of oxidized phosphatidylcholine on biomarkers of oxidative stress in rats. Indian J Clin Biochem. 2011;26(2):154–160. https://doi.org/10.1007/s12291-010-0064-4.Al-Orf SM. Effect of oxidized phosphatidylcholine on biomarkers of oxidative stress in rats. Indian J Clin Biochem. 2011;26(2):154–160. https://doi.org/10.1007/s12291-010-0064-4.Choudhary RC, Kuschner CE, Kazmi J, Mcdevitt L, Espin BB, Essaihi M et al. The Role of Phospholipid Alterations in Mitochondrial and Brain Dysfunction after Cardiac Arrest. Int J Mol Sci. 2024;25(9):4645. https://doi.org/10.3390/ijms25094645.Choudhary RC, Kuschner CE, Kazmi J, Mcdevitt L, Espin BB, Essaihi M et al. The Role of Phospholipid Alterations in Mitochondrial and Brain Dysfunction after Cardiac Arrest. Int J Mol Sci. 2024;25(9):4645. https://doi.org/10.3390/ijms25094645.Osipova D, Kokoreva K, Lazebnik L, Golovanova E, Pavlov C, Dukhanin A et al. Regression of Liver Steatosis Following Phosphatidylcholine Administration: A Review of Molecular and Metabolic Pathways Involved. Front Pharmacol. 2022;13:797923. https://doi.org/10.3389/fphar.2022.797923.Osipova D, Kokoreva K, Lazebnik L, Golovanova E, Pavlov C, Dukhanin A et al. Regression of Liver Steatosis Following Phosphatidylcholine Administration: A Review of Molecular and Metabolic Pathways Involved. Front Pharmacol. 2022;13:797923. https://doi.org/10.3389/fphar.2022.797923.Buang Y, Wang YM, Cha JY, Nagao K, Yanagita T. Dietary phosphatidylcholine alleviates fatty liver induced by orotic acid. Nutrition. 2005;21(7-8): 867–873. https://doi.org/10.1016/j.nut.2004.11.019.Buang Y, Wang YM, Cha JY, Nagao K, Yanagita T. Dietary phosphatidylcholine alleviates fatty liver induced by orotic acid. Nutrition. 2005;21(7-8): 867–873. https://doi.org/10.1016/j.nut.2004.11.019.Lee JM, Lee YK, Mamrosh JL, Busby SA, Griffin PR, Pathak MC et al. A nuclearreceptor-dependent phosphatidylcholine pathway with antidiabetic effects. Nature. 2011;474(7352):506–510. https://doi.org/10.1038/nature10111.Lee JM, Lee YK, Mamrosh JL, Busby SA, Griffin PR, Pathak MC et al. A nuclearreceptor-dependent phosphatidylcholine pathway with antidiabetic effects. Nature. 2011;474(7352):506–510. https://doi.org/10.1038/nature10111.Cao Q, Mak KM, Lieber CS. Dilinoleoylphosphatidylcholine decreases LPS-induced TNF-α generation in Kupffer cells of ethanol-fed rats: respective roles of MAPKs and NF-κB. Biochem Biophys Res Commun. 2002;294(4):849–853. https://doi.org/10.1016/S0006-291X(02)00586-7.Cao Q, Mak KM, Lieber CS. Dilinoleoylphosphatidylcholine decreases LPS-induced TNF-α generation in Kupffer cells of ethanol-fed rats: respective roles of MAPKs and NF-κB. Biochem Biophys Res Commun. 2002;294(4):849–853. https://doi.org/10.1016/S0006-291X(02)00586-7.Chen M, Huang H, Zhou P, Zhang J, Dai Y, Yang D et al. Oral Phosphatidylcholine Improves Intestinal Barrier Function in Drug-Induced Liver Injury in Rats. Gastroenterol Res Pract. 2019;2019:8723460. https://doi.org/10.1155/2019/8723460.Chen M, Huang H, Zhou P, Zhang J, Dai Y, Yang D et al. Oral Phosphatidylcholine Improves Intestinal Barrier Function in Drug-Induced Liver Injury in Rats. Gastroenterol Res Pract. 2019;2019:8723460. https://doi.org/10.1155/2019/8723460.Poniachik J, Baraona E, Zhao J, Lieber CS. Dilinoleoylphosphatidylcholine decreases hepatic stellate cell activation. J Lab Clin Med. 1999;133(4):342–348. https://doi.org/10.1016/s0022-2143(99)90064-1.Poniachik J, Baraona E, Zhao J, Lieber CS. Dilinoleoylphosphatidylcholine decreases hepatic stellate cell activation. J Lab Clin Med. 1999;133(4):342–348. https://doi.org/10.1016/s0022-2143(99)90064-1.Valentino G, Zivko C, Weber F, Brülisauer L, Luciani P. Synergy of Phospholipid-Drug Formulations Significantly Deactivates Profibrogenic Human Hepatic Stellate Cells. Pharmaceutics. 2019;11(12):676. https://doi.org/10.3390/pharmaceutics11120676.Valentino G, Zivko C, Weber F, Brülisauer L, Luciani P. Synergy of PhospholipidDrug Formulations Significantly Deactivates Profibrogenic Human Hepatic Stellate Cells. Pharmaceutics. 2019;11(12):676. https://doi.org/10.3390/pharmaceutics11120676.Cao Q, Mak KM, Lieber CS. Dilinoleoylphosphatidylcholine prevents transforming growth factor-β1-mediated collagen accumulation in cultured rat hepatic stellate cells. J Lab Clin Med. 2002;139(4):202–210. https://doi.org/10.1067/mlc.2002.121853.Cao Q, Mak KM, Lieber CS. Dilinoleoylphosphatidylcholine prevents transforming growth factor-β1-mediated collagen accumulation in cultured rat hepatic stellate cells. J Lab Clin Med. 2002;139(4):202–210. https://doi.org/10.1067/mlc.2002.121853.Cao Q, Mak KM, Lieber CS. DLPC decreases TGF-β1-induced collagen mRNA by inhibiting p38 MAPK in hepatic stellate cells. Am J Physiol Gastrointest Liver Physiol. 2002;283(5):G1051–G1061. https://doi.org/10.1152/ajpgi.00128.2002.Cao Q, Mak KM, Lieber CS. DLPC decreases TGF-β1-induced collagen mRNA by inhibiting p38 MAPK in hepatic stellate cells. Am J Physiol Gastrointest Liver Physiol. 2002;283(5):G1051–G1061. https://doi.org/10.1152/ajpgi.00128.2002.Ma X, Zhao J, Lieber CS. Polyenylphosphatidylcholine attenuates nonalcoholic hepatic fibrosis and accelerates its regression. J Hepatol. 1996;24(5):604–613. https://doi.org/10.1016/s0168-8278(96)80147-4.Ma X, Zhao J, Lieber CS. Polyenylphosphatidylcholine attenuates nonalcoholic hepatic fibrosis and accelerates its regression. J Hepatol. 1996;24(5):604–613. https://doi.org/10.1016/s0168-8278(96)80147-4.Aleynik SI, Leo MA, Ma X, Aleynik MK, Lieber CS. Polyenylphosphatidylcholine prevents carbon tetrachloride-induced lipid peroxidation while it attenuates liver fibrosis. J Hepatol. 1997;27(3):554–561. https://doi.org/10.1016/s0168-8278(97)80361-3.Aleynik SI, Leo MA, Ma X, Aleynik MK, Lieber CS. Polyenylphosphatidylcholine prevents carbon tetrachloride-induced lipid peroxidation while it attenuates liver fibrosis. J Hepatol. 1997;27(3):554–561. https://doi.org/10.1016/s0168-8278(97)80361-3.Fong SY, Brandl M, Bauer-Brandl A. Phospholipid-based solid drug formulations for oral bioavailability enhancement: A metaanalysis. Eur J Pharm Sci. 2015;80:89–110. https://doi.org/10.1016/j.ejps.2015.08.005.Fong SY, Brandl M, Bauer-Brandl A. Phospholipid-based solid drug formulations for oral bioavailability enhancement: A metaanalysis. Eur J Pharm Sci. 2015;80:89–110. https://doi.org/10.1016/j.ejps.2015.08.005.Медведева НВ, Прозоровский ВН, Игнатов ДВ, Дружиловская ОС, Кудинов ВА, Касаткина ЕО и др. Лекарственные препараты и транспортные наносистемы на основе растительных фосфолипидов. Биомедицинская химия. 2015;61(2):219–230. https://doi.org/10.18097/PBMC20156102219.Medvedeva NV, Prozorovskiy VN, Ignatov DV, Druzhilovskaya OS, Kudinov VA, Kasatkina EO et al. Pharmacological agents and transport nanosystems based on plant phospholipids. Biomeditsinskaya Khimiya. 2015;61(2):219–230. (In Russ.) https://doi.org/10.18097/PBMC20156102219.Kuche K, Bhargavi N, Dora CP, Jain S. Drug-Phospholipid Complex – a Go Through Strategy for Enhanced Oral Bioavailability. AAPS PharmSciTech. 2019;20(2):43. https://doi.org/10.1208/s12249-018-1252-4.Kuche K, Bhargavi N, Dora CP, Jain S. Drug-Phospholipid Complex – a Go Through Strategy for Enhanced Oral Bioavailability. AAPS PharmSciTech. 2019;20(2):43. https://doi.org/10.1208/s12249-018-1252-4.Оковитый СВ, Райхельсон КЛ, Приходько ВА. Комбинированная гепатопротекторная фармакотерапия заболеваний печени. Экспериментальная и клиническая гастроэнтерология. 2022;(7):5–20. https://doi.org/10.31146/1682-8658-ecg-203-7-5-20.Okovityi SV, Raikhelson KL, Prikhodko VA. Combined hepatoprotective pharmacotherapy for liver disease. Experimental and Clinical Gastroenterology. 2022;(7):5–20. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-203-7-5-20.Приходько ВА, Оковитый СВ. Фармакодинамические и фармакокинетические особенности комбинированного применения глицирризиновой кислоты. Экспериментальная и клиническая гастроэнтерология. 2023;(8): 141–150. https://doi.org/10.31146/1682-8658-ecg-216-8-141-150.Prikhodko VA, Okovityi SV. Pharmacodynamic and pharmacokinetic aspects of combined use of glycyrrhizinic acid. Experimental and Clinical Gastroenterology. 2023;(8):141–150. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-216-8-141-150.Прозоровский ВН, Ипатова ОМ, Тихонова ЕГ, Захарова ТС, Дружиловская ОС, Короткевич ЕИ, Торховская ТИ. Преднизолон в фосфолипидных наночастицах: пролонгированная циркуляция и повышенное противовоспалительное действие. Биомедицинская химия. 2019;65(3):222–226. https://doi.org/10.18097/PBMC20196503222.Prozorovskii VN, Ipatova OM, Tikhonova EG, Zakharova TS, Druzhilovskaya OS, Korotkevich EI, Torkhovskaya TI. Prednisolone in phospholipid nanoparticles: prolonged circulation and increased antiinflammatory effect. Biomeditsinskaya Khimiya. 2019;65(3):222–226. (In Russ.) https://doi.org/10.18097/PBMC20196503222.Barzaghi N, Crema F, Gatti G, Pifferi G, Perucca E. Pharmacokinetic studies on IdB 1016, a silybinphosphatidylcholine complex, in healthy human subjects. Eur J Drug Metab Pharmacokinet. 1990;15(4):333–338. https://doi.org/10.1007/BF03190223.Barzaghi N, Crema F, Gatti G, Pifferi G, Perucca E. Pharmacokinetic studies on IdB 1016, a silybinphosphatidylcholine complex, in healthy human subjects. Eur J Drug Metab Pharmacokinet. 1990;15(4):333–338. https://doi.org/10.1007/BF03190223.Yanyu X, Yunmei S, Zhipeng C, Qineng P. The preparation of silybinphospholipid complex and the study on its pharmacokinetics in rats. Int J Pharm. 2006;307(1):77–82. https://doi.org/10.1016/j.ijpharm.2005.10.001.Yanyu X, Yunmei S, Zhipeng C, Qineng P. The preparation of silybinphospholipid complex and the study on its pharmacokinetics in rats. Int J Pharm. 2006;307(1):77–82. https://doi.org/10.1016/j.ijpharm.2005.10.001.Ипатова ОМ, Торховская ТИ, Княжев ВА, Карузина ИИ, Бачманова ГИ, Гусева МК, Арчаков АИ. Торможение с помощью нового гепато-протекторного препарата <фосфолив> развития хронического гепатита у крыс. Вопросы медицинской химии. 1998;44(6):537–542. Режим доступа: https://pbmc.ibmc.msk.ru/en/article-en/PBMC-1998-44-6-537/.Ipatova OI, Torkhovskaya TI, Knjazhev VA, Karusina II, Bachmanova GI, Guseva MK, Archakov AI. Hindering of rat chronic hepatit progression by means of new hepatoprotective preparation “phospholiv”. Voprosy Meditsinskoi Khimii. 1998;44(6):537–542. (In Russ.) Available at: https://pbmc.ibmc.msk.ru/en/article-en/PBMC-1998-44-6-537/.Воскресенская АА, Медведева НВ, Прозоровский ВН, Москалева НЕ, Ипатова ОМ. Особенности всасывания глицирризиновой кислоты в составе лекарственного препарата «фосфоглив». Биомедицинская химия. 2012;58(5):564–572. https://doi.org/10.18097/pbmc20125805564.Voskresenskaya AA, Medvedeva NV, Prozorovskiy VN, Moskaleva NE, Ipatova OM. The absorption features of glycyrrhizic acid in composition of drug “phosphogliv”. Biomeditsinskaya Khimiya. 2012;58(5):564–572. (In Russ.) https://doi.org/10.18097/pbmc20125805564.Yue PF, Zhang WJ, Yuan HL, Yang M, Zhu WF, Cai PL, Xiao HX. Process optimization, characterization and pharmacokinetic evaluation in rats of ursodeoxycholic acid-phospholipid complex. AAPS PharmSciTech. 2008;9(1):322–329. https://doi.org/10.1208/s12249-008-9040-1.Yue PF, Zhang WJ, Yuan HL, Yang M, Zhu WF, Cai PL, Xiao HX. Process optimization, characterization and pharmacokinetic evaluation in rats of ursodeoxycholic acid-phospholipid complex. AAPS PharmSciTech. 2008;9(1):322–329. https://doi.org/10.1208/s12249-008-9040-1.Dong XR, Chen QQ, Xue ML, Wang L, Wu Q, Luo TF. Effect of polyene phosphatidylcholine/ursodeoxycholic acid/ademetionine on pregnancy outcomes in intrahepatic cholestasis. World J Clin Cases. 2023;11(27):6431–6439. https://doi.org/10.12998/wjcc.v11.i27.6431.Dong XR, Chen QQ, Xue ML, Wang L, Wu Q, Luo TF. Effect of polyene phosphatidylcholine/ursodeoxycholic acid/ademetionine on pregnancy outcomes in intrahepatic cholestasis. World J Clin Cases. 2023;11(27):6431–6439. https://doi.org/10.12998/wjcc.v11.i27.6431.Maev IV, Samsonov AA, Palgova LK, Pavlov CS, Vovk EI, Shirokova EN, Starostin KM. Effectiveness of phosphatidylcholine in alleviating steatosis in patients with nonalcoholic fatty liver disease and cardiometabolic comorbidities (MANPOWER study). BMJ Open Gastroenterol. 2020;7(1):e000341. https://doi.org/10.1136/bmjgast-2019-000341.Maev IV, Samsonov AA, Palgova LK, Pavlov CS, Vovk EI, Shirokova EN, Starostin KM. Effectiveness of phosphatidylcholine in alleviating steatosis in patients with nonalcoholic fatty liver disease and cardiometabolic comorbidities (MANPOWER study). BMJ Open Gastroenterol. 2020;7(1):e000341. https://doi.org/10.1136/bmjgast-2019-000341.Maev IV, Samsonov AA, Palgova LK, Pavlov CS, Shirokova EN, Vovk EI, Starostin KM. Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: real-life observational study from Russia. BMJ Open Gastroenterol. 2020;7(1):e000368. https://doi.org/10.1136/bmjgast-2019-000368.Maev IV, Samsonov AA, Palgova LK, Pavlov CS, Shirokova EN, Vovk EI, Starostin KM. Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: real-life observational study from Russia. BMJ Open Gastroenterol. 2020;7(1):e000368. https://doi.org/10.1136/bmjgast-2019-000368.Du Q. Treatment of 52 cases with hepatic dysfunctional fatty liver with Essentiale®. Chin J Gastro Hepa. 2004;13:2. (In Chinese)Du Q. Treatment of 52 cases with hepatic dysfunctional fatty liver with Essentiale®. Chin J Gastro Hepa. 2004;13:2. (In Chinese)Liang H. Discussion of treatment of fatty liver using polyene phosphatidylcholine capsules. Chin Med Fact Mine. 2006;19:43. (In Chinese)Liang H. Discussion of treatment of fatty liver using polyene phosphatidylcholine capsules. Chin Med Fact Mine. 2006;19:43. (In Chinese)Shen Z. Observation of efficacy in 100 patients with non-alcoholic fatty liver disease treated with Essentiale. Chin J Curr Clin Med. 2007;5(8):693–694. (In Chinese)Shen Z. Observation of efficacy in 100 patients with non-alcoholic fatty liver disease treated with Essentiale. Chin J Curr Clin Med. 2007;5(8):693–694. (In Chinese)Wan L, Xue B. Efficacy study of ursodeoxycholic acid in the treatment of non-alcoholic fatty liver. Med Inf. 2013;26(11):605–606. (In Chinese)Wan L, Xue B. Efficacy study of ursodeoxycholic acid in the treatment of non-alcoholic fatty liver. Med Inf. 2013;26(11):605–606. (In Chinese)Wu CY. Comparison of metformin and polyene phosphatidylcholine for nonalcoholic fatty liver disease. Pract Clin Med. 2015;16(5):3–5. (In Chinese) https://doi.org/10.13764/j.cnki.lcsy.2015.05.002.Wu CY. Comparison of metformin and polyene phosphatidylcholine for nonalcoholic fatty liver disease. Pract Clin Med. 2015;16(5):3–5. (In Chinese) https://doi.org/10.13764/j.cnki.lcsy.2015.05.002.Степанов ЮМ. Применение эссенциальных фосфолипидов для лечения жировой болезни печени. Гастроэнтерология. 2016;(4):58–64. https://doi.org/10.22141/2308-2097.4.62.2016.81089.Stepanov YuM. The use of essential phospholipids for the treatment of fatty liver disease. Gastroenterology. 2016;(4):58–64. (In Russ.) https://doi.org/10.22141/2308-2097.4.62.2016.81089.Dajani AI, Abuhammour A. Agents for the treatment of fatty liver disease: focus on essential phospholipids. Drug Ther Perspect. 2021;37:249–264. https://doi.org/10.1007/s40267-021-00838-x.Dajani AI, Abuhammour A. Agents for the treatment of fatty liver disease: focus on essential phospholipids. Drug Ther Perspect. 2021;37:249–264. https://doi.org/10.1007/s40267-021-00838-x.Zhou SY, Sun ZY. Therapeutic efficacy of polyunsaturated phosphatidylcholine on fatty liver disease. J Clin Hepatol. 2010;26(3):286–287. (In Chinese) https://doi.org/10.3969/j.issn.1001-5256.2010.03.022.Zhou SY, Sun ZY. Therapeutic efficacy of polyunsaturated phosphatidylcholine on fatty liver disease. J Clin Hepatol. 2010;26(3):286–287. (In Chinese) https://doi.org/10.3969/j.issn.1001-5256.2010.03.022.Wang W, Shi LP, Shi L, Xu L. Efficacy of probiotics on the treatment of nonalcoholic fatty liver disease. Chin J Intern Med. 2018;57(2):101–107. (In Chinese) https://doi.org/10.3760/cma.j.issn.0578-1426.2018.02.004.Wang W, Shi LP, Shi L, Xu L. Efficacy of probiotics on the treatment of nonalcoholic fatty liver disease. Chin J Intern Med. 2018;57(2):101–107. (In Chinese) https://doi.org/10.3760/cma.j.issn.0578-1426.2018.02.004.Guo X, Liang P, Xu Y. Comparison of efficacies of diammonium glycyrrhizinate and polyene phosphatidylcholine on nonalcoholic steatohepatitis. Chin J New Drugs. 2012;21(3):289–293. (In Chinese) Available at: https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zgxyzz201203012.Guo X, Liang P, Xu Y. Comparison of efficacies of diammonium glycyrrhizinate and polyene phosphatidylcholine on nonalcoholic steatohepatitis. Chin J New Drugs. 2012;21(3):289–293. (In Chinese) Available at: https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zgxyzz201203012.Zhan G, Tan H, Li F, Li R, Li G. Clinical observation of polyene phosphatidylcholine combined with lifestyle intervention in treatment of patients with non-alcoholic steatohepatitis. J Clin Hepatol. 2013;16(6):505–508. https://doi.org/10.3969/j.issn.1672-5069.2013.06.009.Zhan G, Tan H, Li F, Li R, Li G. Clinical observation of polyene phosphatidylcholine combined with lifestyle intervention in treatment of patients with non-alcoholic steatohepatitis. J Clin Hepatol. 2013;16(6):505–508. https://doi.org/10.3969/j.issn.1672-5069.2013.06.009.Ohbayashi H. Twelve-month chronic administration of polyenephosphatidylcholine (EPL®) for improving hepatic function of fatty liver patients. Prog Med. 2004;24(7):1751–1756. (In Japanese)Ohbayashi H. Twelve-month chronic administration of polyenephosphatidylcholine (EPL®) for improving hepatic function of fatty liver patients. Prog Med. 2004;24(7):1751–1756. (In Japanese)Zhuang XS, Zhang ZJ. Study of ursodeoxycholic acid (UDCA) combined with polyene phosphatidylcholine in the treatment of non-alcoholic steatohepatitis. China Pract Med. 2009;4(10):11–12. (In Chinese)Zhuang XS, Zhang ZJ. Study of ursodeoxycholic acid (UDCA) combined with polyene phosphatidylcholine in the treatment of non-alcoholic steatohepatitis. China Pract Med. 2009;4(10):11–12. (In Chinese)Буеверов АО, Ешану ВС, Маевская МВ, Ивашкин ВТ. Эссенциальные фосфолипиды в комплексной терапии стеатогепатита смешанного генеза. Клинические перспективы гастроэнтерологии, гепатологии. 2008;(1):17–23. Режим доступа: https://elibrary.ru/ijswcp.Buyeverov AO, Yeshanu VS, Mayevskaya MV, Ivashkin VT. Application of essential phospholipids in complex therapy of steatohepatitis of the mixed origin. Klinicheskie Perspektivy Gastroenterologii, Gepatologii. 2008;(1):17–23. (In Russ.) Available at: https://elibrary.ru/ijswcp.Sanyal AJ, Nakajima A, Bugianesi E, Sebastiani G, Schattenberg JM, Adams LA et al. Expert Delphi Consensus on Surrogate Endpoints for Treatment Assessment in Metabolic Dysfunction-associated Steatohepatitis. Clin Gastroenterol Hepatol. 2025. https://doi.org/10.1016/j.cgh.2025.12.001.Sanyal AJ, Nakajima A, Bugianesi E, Sebastiani G, Schattenberg JM, Adams LA et al. Expert Delphi Consensus on Surrogate Endpoints for Treatment Assessment in Metabolic Dysfunction-associated Steatohepatitis. Clin Gastroenterol Hepatol. 2025. https://doi.org/10.1016/j.cgh.2025.12.001.Watanabe A, Kobayashi M, Morishita N, Nagashima H. Multimodal treatment resulting in rapid improvement of fatty liver in obese patients. Curr Ther Res. 1988;43(2):239–246.Watanabe A, Kobayashi M, Morishita N, Nagashima H. Multimodal treatment resulting in rapid improvement of fatty liver in obese patients. Curr Ther Res. 1988;43(2):239–246.Gonciarz Z, Besser P, Lelek E, Gundermann KJ, Johannes KJ. Randomised placebo-controlled double blind trial on “essential” phospholipids in the treatment of fatty liver associated with diabetes. Med Chir Dig. 1988;17(1):61–65. Available at: https://www.researchgate.net/publication/292301344_Randomised_placebo-controlled_double_blind_trial_on_'essential'_phospholipids_in_the_treatment_of_fatty_liver_associated_with_diabetes.Gonciarz Z, Besser P, Lelek E, Gundermann KJ, Johannes KJ. Randomised placebo-controlled double blind trial on “essential” phospholipids in the treatment of fatty liver associated with diabetes. Med Chir Dig. 1988;17(1):61–65. Available at: https://www.researchgate.net/publication/292301344_Randomised_placebo-controlled_double_blind_trial_on_'essential'_phospholipids_in_the_treatment_of_fatty_liver_associated_with_diabetes.Cairella M, Callisto F, Godi R, Marchini G. Polyunsaturated phosphatidylcholine combined with vitamin B complex in the treatment of patients with disorders of the hepatobiliary function caused by unbalanced nutrition. Clin Ter. 1989;131(4):237–246. (In Italian) Available at: https://pubmed.ncbi.nlm.nih.gov/2532093/.Cairella M, Callisto F, Godi R, Marchini G. Polyunsaturated phosphatidylcholine combined with vitamin B complex in the treatment of patients with disorders of the hepatobiliary function caused by unbalanced nutrition. Clin Ter. 1989;131(4):237–246. (In Italian) Available at: https://pubmed.ncbi.nlm.nih.gov/2532093/.Koga S, Irisa T, Miyata Y, Sakai H, Tsuji Y, Fujimoto A et al. Clinical progress of 51 fatty liver cases analyzed by liver function tests and ultrasonic screening and results of EPL administered cases. Prog Med. 1991;11(7):1891–1899. (In Japanese)Koga S, Irisa T, Miyata Y, Sakai H, Tsuji Y, Fujimoto A et al. Clinical progress of 51 fatty liver cases analyzed by liver function tests and ultrasonic screening and results of EPL administered cases. Prog Med. 1991;11(7):1891–1899. (In Japanese)Li JH, Chen XY, Zhong CF, Min J. A randomized controlled study of essential phospholipids (Essentiale capsules) in the treatment of fatty liver. Infect Dis Info. 2000;13(4):180–181. (In Chinese)Li JH, Chen XY, Zhong CF, Min J. A randomized controlled study of essential phospholipids (Essentiale capsules) in the treatment of fatty liver. Infect Dis Info. 2000;13(4):180–181. (In Chinese)Arvind N, Savaikar P, Rajkumar JS. Therapy for NAFLD – comparative study of essential phospholipids vs ursodeoxycholic acid. Ind J Clin Pract. 2006;16(10):21–24. Available at: https://www.researchgate.net/publication/292305838_Therapy_for_NAFLD_-_A_comparative_study_of_essential_phospholipids_vs_ursodeoxycholic_acid.Arvind N, Savaikar P, Rajkumar JS. Therapy for NAFLD – comparative study of essential phospholipids vs ursodeoxycholic acid. Ind J Clin Pract. 2006;16(10):21–24. Available at: https://www.researchgate.net/publication/292305838_Therapy_for_NAFLD_-_A_comparative_study_of_essential_phospholipids_vs_ursodeoxycholic_acid.Fan XF, Deng YQ, Ye L, Li Y, Chen J, Lu WW, Li JP. Effect of Xuezhikang capsule on serum tumor necrosis factor-α and interleukin-6 in patients with nonalcoholic fatty liver disease and hyperlipidemia. Chin J Integr Med. 2010;16(2):119–123. https://doi.org/10.1007/s11655-010-0119-7.Fan XF, Deng YQ, Ye L, Li Y, Chen J, Lu WW, Li JP. Effect of Xuezhikang capsule on serum tumor necrosis factor-α and interleukin-6 in patients with nonalcoholic fatty liver disease and hyperlipidemia. Chin J Integr Med. 2010;16(2):119–123. https://doi.org/10.1007/s11655-010-0119-7.Sun C, Zheng X, Tan Z, Cui F, Zhang R, Zhang H. Clinical observation on polyene phosphatidyl choline and metformin in the treatment of type 2 diabetes and non-alcoholic fatty liver disease. Clin Focus. 2008;23(17):1272–1273. (In Chinese)Sun C, Zheng X, Tan Z, Cui F, Zhang R, Zhang H. Clinical observation on polyene phosphatidyl choline and metformin in the treatment of type 2 diabetes and non-alcoholic fatty liver disease. Clin Focus. 2008;23(17):1272–1273. (In Chinese)Wu Y. Efficacy analysis of polyene phosphatidylcholine for type 2 diabetes complicated with fatty liver. Hunan Zhong Yiyao Daxue Xuebao. 2009;29(12):41–42. (In Chinese)Wu Y. Efficacy analysis of polyene phosphatidylcholine for type 2 diabetes complicated with fatty liver. Hunan Zhong Yiyao Daxue Xuebao. 2009;29(12):41–42. (In Chinese)Sas E, Grinevich V, Kravchuk U. PTU-080 Polyunsaturate phosphatidylcholine and sibutramine decrease the liver fibrosis progress in patients with non-alcoholic liver disease. Gut. 2012;61(S2):A216–A217. https://doi.org/10.1136/gutjnl-2012-302514c.80.Sas E, Grinevich V, Kravchuk U. PTU-080 Polyunsaturate phosphatidylcholine and sibutramine decrease the liver fibrosis progress in patients with non-alcoholic liver disease. Gut. 2012;61(S2):A216–A217. https://doi.org/10.1136/gutjnl-2012-302514c.80.Li Z. Efficacy of polyene phosphatidylcholine in combination with metformin for diabetes complicated with non-alcoholic fatty liver disease. Inner Mongol J Tradition Chin Med. 2013;31:10–11. (In Chinese)Li Z. Efficacy of polyene phosphatidylcholine in combination with metformin for diabetes complicated with non-alcoholic fatty liver disease. Inner Mongol J Tradition Chin Med. 2013;31:10–11. (In Chinese)Lu XY, Ye GL. Clinical trial of polyene phosphatidylcholine in the treatment of moderate and sever fatty liver in the elderly. Chin J Clin Pharmacol. 2016;32(15):1370–1375. (In Chinese)Lu XY, Ye GL. Clinical trial of polyene phosphatidylcholine in the treatment of moderate and sever fatty liver in the elderly. Chin J Clin Pharmacol. 2016;32(15):1370–1375. (In Chinese)Elwakil R, Mansy AES, Shaheen SM, Barakat A, Abou-Seada NMN, El Hamamsy M. Efficacy of adjuvant phosphatidylcholine in the management of egyptian patients with non alcoholic fatty liver disease (NAFLD). Med Clin Res. 2021;6(8):669–677. Available at: https://www.medclinrese.org/open-access/efficacy-of-adjuvant-phosphatidylcholine-in-the-managementof-egyptian-patients-with-non-alcoholic-fatty-liver-disease-n.pdf.Elwakil R, Mansy AES, Shaheen SM, Barakat A, Abou-Seada NMN, El Hamamsy M. Efficacy of adjuvant phosphatidylcholine in the management of egyptian patients with non alcoholic fatty liver disease (NAFLD). Med Clin Res. 2021;6(8):669–677. Available at: https://www.medclinrese.org/open-access/efficacy-of-adjuvant-phosphatidylcholine-in-the-managementof-egyptian-patients-with-non-alcoholic-fatty-liver-disease-n.pdf.Yin D, Kong L. Observation for curative effect of Essentiale in treatment of fatty liver caused by diabetes mellitus. Med J Q Ilu. 2000;15:277–278. (In Chinese)Yin D, Kong L. Observation for curative effect of Essentiale in treatment of fatty liver caused by diabetes mellitus. Med J Q Ilu. 2000;15:277–278. (In Chinese)Poongothai S, Karkuzhali K, Siva Prakash G, Sangeetha T, Saravanan G, Deepa R et al. Effect of essentiale in diabetic subjects with non-alcoholic fatty liver. Int J Diab Dev Ctries. 2005;25(1):12–19. Available at: https://scispace.com/pdf/effect-of-essentiale-in-diabetic-subjects-withnon-alcoholic-565k3ik6vp.pdf.Poongothai S, Karkuzhali K, Siva Prakash G, Sangeetha T, Saravanan G, Deepa R et al. Effect of essentiale in diabetic subjects with non-alcoholic fatty liver. Int J Diab Dev Ctries. 2005;25(1):12–19. Available at: https://scispace.com/pdf/effect-of-essentiale-in-diabetic-subjects-withnon-alcoholic-565k3ik6vp.pdf.Dajani AI, Abu Hammour AM, Zakaria MA, Al Jaberi MR, Nounou MA, Semrin AI. Essential phospholipids as a supportive adjunct in the management of patients with NAFLD. Arab J Gastroenterol. 2015;16(3-4):99–104. https://doi.org/10.1016/j.ajg.2015.09.001.Dajani AI, Abu Hammour AM, Zakaria MA, Al Jaberi MR, Nounou MA, Semrin AI. Essential phospholipids as a supportive adjunct in the management of patients with NAFLD. Arab J Gastroenterol. 2015;16(3-4):99–104. https://doi.org/10.1016/j.ajg.2015.09.001.Xu R, Xi Q. Efficacy of ezetimibe in the treatment of nonobese patients with nonalcoholic fatty liver disease. Chin J Convalescent Med. 2017;26:760–762. (In Chinese) https://doi.org/10.13517/j.cnki.ccm.2017.07.039.Xu R, Xi Q. Efficacy of ezetimibe in the treatment of nonobese patients with nonalcoholic fatty liver disease. Chin J Convalescent Med. 2017;26:760–762. (In Chinese) https://doi.org/10.13517/j.cnki.ccm.2017.07.039.Shen G, Huang L, He C, Huang J, Zeng G, Li M. Clinical effects of ezetimibe on the treatment of patients with nonalcoholic fatty liver disease. Chin Hepatology. 2023;28:1219–1221. (In Chinese) https://doi.org/10.3969/j.issn.1008-1704.2023.10.021.Shen G, Huang L, He C, Huang J, Zeng G, Li M. Clinical effects of ezetimibe on the treatment of patients with nonalcoholic fatty liver disease. Chin Hepatology. 2023;28:1219–1221. (In Chinese) https://doi.org/10.3969/j.issn.1008-1704.2023.10.021.Wang R, Liu X. Efficacy of liraglutide combined with polyene phosphatidylcholine in the treatment of non-alcoholic fatty liver disease and its effect on oxidative stress. Med Theory Practice. 2023;36(13):2220–2223. (In Chinese) https://doi.org/10.19381/j.issn.1001-7585.2023.13.020.Wang R, Liu X. Efficacy of liraglutide combined with polyene phosphatidylcholine in the treatment of non-alcoholic fatty liver disease and its effect on oxidative stress. Med Theory Practice. 2023;36(13):2220–2223. (In Chinese) https://doi.org/10.19381/j.issn.1001-7585.2023.13.020.Qi N, Wang M, Hou Y. Analysis of the Efficacy of Polyene Phosphatidylcholine Combined with Simegallutide in Nonalcoholic Fatty Liver Disease. J Jinzhou Med Univ. 2024;5(5):75–78 (In Chinese) Available at: https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_jzyxyxb202405015.Qi N, Wang M, Hou Y. Analysis of the Efficacy of Polyene Phosphatidylcholine Combined with Simegallutide in Nonalcoholic Fatty Liver Disease. J Jinzhou Med Univ. 2024;5(5):75–78 (In Chinese) Available at: https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_jzyxyxb202405015.Jin Y, Liu T, Tong Z, Dong M. Analysis of the Efficacy of Polyenyl Phosphatidylcholine in Combination with Liraglutide in Nonalcoholic Fatty Liver Disease and the Effect of Omentin-1 and Vaspin Expression. Altern Ther Health Med. 2025;31(4):273–277. Available at: https://alternative-therapies.com/oa/index.html?fid=10677.Jin Y, Liu T, Tong Z, Dong M. Analysis of the Efficacy of Polyenyl Phosphatidylcholine in Combination with Liraglutide in Nonalcoholic Fatty Liver Disease and the Effect of Omentin-1 and Vaspin Expression. Altern Ther Health Med. 2025;31(4):273–277. Available at: https://alternative-therapies.com/oa/index.html?fid=10677.Stefan N, Hartleb M, Fan J, Demir M, Schattenberg JM, Gietka J et al. Effect of Essential Phospholipids in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Randomised Phase 4 Clinical Trial. Liver Int. 2026;46(5):e70601. https://doi.org/10.1111/liv.70601.Stefan N, Hartleb M, Fan J, Demir M, Schattenberg JM, Gietka J et al. Effect of Essential Phospholipids in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Randomised Phase 4 Clinical Trial. Liver Int. 2026;46(5):e70601. https://doi.org/10.1111/liv.70601.

The authors declare that there are no conflicts of interest present.