Effects of Curcuminoids Plus Piperine Co-Supplementation on Liver Enzymes and Inflammation in Adults: A GRADE-Assessed Systematic Review and Meta-Analysis.

Chronic diseases and inflammation are often linked to elevated liver enzymes and inflammatory markers. Studies suggest that curcuminoid and piperine co-supplementation (Cur + Pip), which enhances bioavailability, may offer beneficial effects. However, previous findings have been inconsistent. This meta-analysis aims to evaluate the effectiveness of Cur + Pip on liver enzymes and inflammation in adults. A comprehensive search of scientific databases was conducted until April 2025 to identify relevant randomized controlled trials (RCTs) involving adults. Included studies compared Cur + Pip with placebo, control, or no treatment, focusing on changes in liver enzymes and inflammatory markers as main outcomes. Data from eligible studies were extracted, and pooled effect sizes were calculated using weighted mean differences (WMDs) with 95% confidence intervals (CIs) under a random-effects model. The pooled analysis of 18 RCTs showed that Cur + Pip significantly reduced AST (WMD: -2.29 IU,  = 0.019) and IL-6 (WMD: -5.59,  < 0.001), whereas changes in ALT (WMD: -3.88 IU,  = 0.053), ALP (WMD: -15.74 IU,  = 0.095), CRP (WMD: -1.53 mg/dL,  = 0.222), and TNF-α (WMD: -0.77,  = 0.314) were not statistically significant. Subgroup analysis revealed that reductions in ALT were significant in individuals with metabolic dysfunction (WMD: -4.64 IU,  = 0.044) and adults with overweight (WMD: -4.89 IU,  = 0.048). AST reductions were more pronounced in prolonged supplementation (≥ 12 weeks) (WMD: -4.08 IU,  < 0.001) and in overweight participants (WMD: -3.04 IU,  = 0.020). Cur + Pip demonstrated beneficial effects on liver enzymes, particularly AST, and showed a positive trend for ALT, especially in overweight or metabolically at-risk individuals. The observed reduction in IL-6 supports their potential anti-inflammatory properties, although no significant effects were seen for CRP or TNF-α. These findings suggest therapeutic promise in specific populations, but further large-scale, long-duration trials are necessary to confirm efficacy and establish clinical significance.