Abstract   Objectives : Nonalcoholic Fatty Liver Disease (NAFLD) is a metabolic disease syndrome with progressive disease development leading to cirrhosis and liver cancer. Electroacupuncture (EA) is a non-pharmacological therapy. The aim of this systematic review is to assess the efficacy and safety of electroacupuncture in the treatment of NAFLD. Design Systematic review and meta- analysis. Data sources: A comprehensive database search was conducted using PubMed, Embase, the Cochrane Library, Web of Science, Cnki, Wan Fang, VIP to identify randomized controlled trials (RCTs) investigating the impact of electroacupuncture (EA) on Non-alcoholic fatty liver disease. RCTs published until July 31, 2024, that met our predetermined inclusion and exclusion criteria were included. Data extraction, literature review, and assessment of the methodological quality of the trials were performed. The meta-analysis was conducted using StataSE version 16. Eligibility criteria for selecting studies We included randomized controlled trials (RCTs) about electroacupuncture for non-alcoholic fatty liver disease?The primary indicators :1. Alanine Aminotransferase (ALT), 2. Aspartate Aminotransferase (AST), 3. Gamma-Glutamyl Transpeptidase (GGT), 4. Triglycerides (TG), 5. Total Cholesterol (TC). Secondary indicators:1. PCIII (Pre-type III collagen), 2. HA (hyaluronidase), 3. LN (laminin), 4. CIV (collagen type IV). Data extraction and synthesis Two independent reviewers conducted separate searches of the databases, assessed eligible articles for inclusion and employed the Cochrane Collaboration’s tool for assessing the risk of bias. The analyses were performed using RevMan 5.3 and StataSE version 16 software. The mean difference (MD) with 95% CI was employed to analyze continuous outcomes.     Results: The primary outcome was Triglycerides (TG), Total cholesterol (TC), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Gamma-glutamyl transpeptidase (GGT). The secondary outcomes were Laminin (LN), Hyaluronidase (HA), Pre-type III collagen (PCIII), Collagen type IV (CIV). Our meta-analysis includes 986 patients from 11 RCTs incorporated. Main result?The Triglycerides (TG) (SMD=-0.84, 95%CI=-1.03,-0.65, P=0.000), Total cholesterol (TC) (SMD=-0.48, 95%CI=-0.62,-0.35, P=0.000), Alanine aminotransferase (ALT) (SMD=-1.48, 95%CI=-1.98,-0.98, P=0.000), Aspartate aminotransferase (AST) (SMD=-0.84, 95%CI=-1.08, -0.60, P=0.000), Gamma-glutamyl transpeptidase (GGT) (SMD=-1.21, 95%CI=-1.59, -0.84, P=0.000). There was a statistically significant difference between the electroacupuncture group and the drug group in terms of improvement in liver blood indices such as lipids. The secondary Laminin (LN) (SMD=-1.90, 95%CI=-2.13, -1.67, P=0.000), Hyaluronidase (HA) (SMD=-3.42, 95%CI=-3.72, -3.12, P=0.000), Pre-type III collagen (PCIII) (SMD=-0.41, 95%CI=-0.62, -0.19, P=0.000), Collagen type IV (CIV) (SMD=-1.08, 95%CI=-1.28, -0.87, P=0.000). There was a statistically significant difference between the electroacupuncture group, and the drug group compared to the drug group in terms of the four indices of liver fibrosis.   Conclusions: Compared to the control group, the addition of electroacupuncture significantly improved Triglycerides (TG), Total cholesterol (TC), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Gamma-glutamyl transpeptidase (GGT), Laminin (LN), Hyaluronidase (HA), Pre-type III collagen (PCIII), Collagen type IV (CIV)with laboratory blood indicators of Non-alcoholic fatty liver disease. Electroacupuncture helps improve lipid levels and fibrosis progression in non-alcoholic fatty liver disease.   Keywords: Non-alcoholic fatty liver disease, electroacupuncture, triglycerides, randomized controlled trials, systematic review, meta-analysis

The authors have declared no competing interest.

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Ethics and dissemination The study did not involve participants' personal data and therefore did not require ethical approval. This systematic review will be published in a peer-reviewed journal.

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