Sir,Recently I read an article by Singhal et al.[1] with great interest and have following comments. Authors conclude that “Pathya (Ayurvedic dietary regime and physical exercise) alone has not been found sufficient to treat this syndrome. Instead, a combination of herbomineral drugs (Ārogyavardhinī vaṭi and Triphalā Guggulu) and pathya/apathya have resulted in significant improvement in liver functions and body mass index (BMI) of non-alcoholic fatty liver disease (NAFLD) patients”. However, the overall results are difficult to conclude. For biochemical parameters [Table 5][1] P values were significant for all the parameters (before versus after treatment) in both groups, except for fasting blood sugar. Though, there are small numerical differences in biochemical parameters and some improvement seen in clinical symptoms, the overall conclusion of group A performing better than group B could be difficult, at least based on this open-label study with small sample size.Authors report this study as retrospective study; however, the methods employed clearly demonstrate that the study is prospective in nature. It will be of interest to know if any ethics committee reviewed and approved the study protocol? Did the patients and their relatives (if applicable) provide written informed consent? How the sample size was calculated? It would have been better if the baseline demographics had been shown for both groups for better comparison, including history of previous and concomitant medications and results stratified by grades.The ‘NAFLD activity score’ a standard outcome measure for NAFLD studies was also not included in this study.
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Author is an employee of Tata Consultancy Services, Mumbai, however the views presented in this letter are of the author and not necessarily of his employer.