Hanieh Barghchi - Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Narges Milkarizi - Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
Zahra Dehnavi - Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Vahid-Reza Askari - Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
Farnood RajabZadeh - Department of Radiology, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran.
Andisheh Norouzian Ostad - Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Lida Jarahi - Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ladan Goshayeshi - Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Seyyed Reza Sobhani - Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohsen Nematy - Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Introduction: Nowadays, improving anxiety, depression, and stress is important in managing non-alcoholic fatty liver (NAFLD). Thus, this study aimed to evaluate eight weeks of pomegranate peel (PP) supplementation on depression, anxiety, and stress scale changes among NAFLD patients. Methods: This randomized clinical trial was conducted on ۷۶ NAFLD patients assigned to the PP (n=۳۹) or placebo (n=۳۷) groups. Participants received the pomegranate peel (۱۵۰۰ mg/day) or placebo for eight weeks. PP capsules were prepared fromdry extract of PP by soaking. A diet with reduced calorie intake and healthy recommendations was given to all participants. The status of NAFLD was checked with two-dimensional elastography. Mental health was evaluated using depression, anxiety, and stress scale, and dietary intake was assessed by ۳-day recall before and after the intervention. Results: The average age of the participants was ۴۳.۱±۸.۶ years, of whom ۵۱.۳% were women. In the PP group, weight, liver stiffness, and hepatorenal sonography index changes significantly differed from the placebo group before and after adjusting potential covariates, including weight and physical activity (P< ۰.۰۰۱). Depression and stress scores changed significantly in the PP group during the study before and after adjusting potential covariates (P= ۰.۰۰۲, ۰.۰۵, respectively). Anxiety score changes were insignificant between the two groups (P= ۰.۱). Conclusion: Based on the results, eight-week supplementation of pomegranate peel ameliorated depression and stress symptoms among NAFLD patients.

Fatty liver, pomegranate peel, Depression, Anxiety, stress