JAMA Netw Open

Berberine fails to reduce visceral or liver fat in adults with obesity

January 21, 2026

In the randomized BRAVO trial (NCT05647915) involving 337 diabetes-free adults with obesity and metabolic dysfunction–associated steatotic liver disease (MASLD), berberine 1 g/day didn't reduce visceral fat or liver fat compared with placebo. Adherence exceeded 90% in both groups. Changes in fat measures were minimal and not significantly different between arms. Berberine was associated with greater reductions in LDL cholesterol, apolipoprotein B, and high-sensitivity C‑reactive protein, although other metabolic markers were unchanged. Adverse event rates were similar between groups.

Clinical takeaway: Berberine appears safe but should not be recommended for reducing visceral or hepatic fat in patients with obesity and MASLD; continue emphasizing evidence‑based weight and liver disease interventions.

Source:

Lei L, et al; BRAVO Collaborative Group. (2026, January 2). JAMA Netw Open. Berberine and Adiposity in Diabetes-Free Individuals With Obesity and MASLD: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41543854/