Researchers tested whether allopurinol, a medicine commonly used to treat gout, could help people with fatty liver disease caused by metabolic problems. They studied 104 patients for 6 months—some took allopurinol plus followed a reduced-calorie diet, while others only followed the diet. The allopurinol group showed improvements in liver ultrasounds and liver enzyme levels compared to their starting point. However, when comparing the two groups directly, the differences weren’t strong enough to prove allopurinol was the reason for the improvement. The diet alone may have been responsible for much of the benefit.

The Quick Take

  • What they studied: Whether taking allopurinol (a medicine that lowers uric acid in the blood) could improve fatty liver disease when combined with a reduced-calorie diet.
  • Who participated: 104 adults with metabolic dysfunction-associated steatotic liver disease (fatty liver caused by metabolism problems). They were randomly split into two groups: 51 received allopurinol plus diet changes, and 53 received diet changes alone.
  • Key finding: The allopurinol group showed improvements in liver ultrasound images and liver enzyme levels after 6 months. However, the control group (diet only) didn’t show the same improvements, yet the difference between groups wasn’t statistically significant enough to confidently say allopurinol was responsible.
  • What it means for you: While allopurinol may help some people with fatty liver disease, this study doesn’t provide strong enough evidence to recommend it as a standard treatment. Diet changes alone remain the most proven approach. Talk to your doctor before considering allopurinol for liver health.

The Research Details

This was a randomized controlled trial, which is considered one of the strongest types of medical research. Researchers randomly assigned 104 patients with fatty liver disease into two groups. One group took 100 mg of allopurinol daily (a medicine that reduces uric acid) plus followed a reduced-calorie diet for 6 months. The other group followed the same diet but took no allopurinol. At the beginning and end of the study, doctors took ultrasound images of the patients’ livers and measured liver enzyme levels in their blood.

The researchers chose allopurinol because previous research suggested that uric acid might play a role in developing fatty liver disease. By lowering uric acid levels, they hoped allopurinol might help the liver heal. They measured success using two methods: ultrasound images that show how much fat is in the liver, and blood tests measuring liver enzymes (AST and ALT), which indicate liver damage.

To make sure the results were fair, researchers used statistical methods to account for differences between the groups at the start, including age, sex, weight, and starting liver enzyme levels.

This study design is important because it helps determine whether allopurinol itself causes improvements or whether diet changes alone are responsible. By comparing two groups treated differently, researchers can separate the effects of the medication from the effects of diet. This type of study is more reliable than simply observing patients taking allopurinol without a comparison group.

Strengths: This was a randomized controlled trial with a reasonable sample size (104 patients), which is a solid research design. Researchers used objective measurements (ultrasound and blood tests) rather than relying on patient reports. They also adjusted their analysis for factors that could affect results. Weaknesses: The study was relatively short (6 months), so long-term effects are unknown. The study didn’t show a clear advantage of allopurinol over diet alone, which raises questions about whether the medication truly helps beyond what diet can achieve.

What the Results Show

In the allopurinol group, ultrasound images of the liver showed significant improvement from the start to the 6-month mark. The liver appeared healthier with less fat buildup. Additionally, blood tests showed that liver enzymes (ALT and AST) decreased significantly in the allopurinol group, suggesting less liver damage.

However, when researchers compared the allopurinol group directly to the diet-only group, the differences between them were not statistically significant. This means the improvements in the allopurinol group could have happened by chance or could have been caused by the diet rather than the medication.

Interestingly, in the allopurinol group, uric acid levels correlated with liver enzyme levels at the 6-month mark, suggesting a connection between uric acid and liver health in people taking the medication. This relationship was not seen in the control group.

The diet-only group did not show significant improvements in ultrasound images or liver enzyme levels, though they were following the same reduced-calorie diet as the allopurinol group.

The study found that within the allopurinol-treated group, there was a meaningful relationship between how much uric acid decreased and how much liver enzymes improved. This suggests that allopurinol’s ability to lower uric acid might be connected to liver improvement. However, this connection was not observed in the diet-only group, which is puzzling and suggests the findings need further investigation.

This research builds on earlier studies suggesting that uric acid plays a role in fatty liver disease development. Previous research showed that people with higher uric acid levels tend to have more liver problems. This study tested whether lowering uric acid with medication could help, but the results are mixed. The findings don’t strongly support using allopurinol as a standard treatment, unlike diet changes, which have consistently shown benefits in previous research.

Several important limitations should be considered: First, the study only lasted 6 months, so we don’t know if benefits continue or improve over longer periods. Second, the study didn’t show that allopurinol was better than diet alone, which is the main question researchers wanted to answer. Third, the sample size (104 people) is relatively small for this type of research. Fourth, the study didn’t measure other important factors like exercise, alcohol use, or other lifestyle changes that could affect results. Finally, the study was published very recently (January 2026), so other researchers haven’t had time to review and confirm the findings.

The Bottom Line

Based on this study alone, allopurinol cannot be recommended as a standard treatment for fatty liver disease. The evidence is mixed and doesn’t clearly show it’s better than diet changes alone. However, the study does suggest allopurinol may help some people when combined with diet. If you have fatty liver disease, focus first on proven strategies: losing weight through a reduced-calorie diet and increasing physical activity. If you’re interested in allopurinol, discuss it with your doctor, especially if you also have gout or high uric acid levels. More research is needed before making strong recommendations.

This research is relevant to people with metabolic dysfunction-associated steatotic liver disease (fatty liver caused by metabolism problems, often linked to obesity and diabetes). It may be particularly interesting to people who have both fatty liver disease and gout or high uric acid levels. However, the findings are not strong enough to change current treatment recommendations for most people. People without liver disease don’t need to consider this information.

In this study, improvements appeared within 6 months. However, this is a relatively short timeframe. Real-world benefits might take longer to appear, or they might continue to improve beyond 6 months. Realistic expectations: If you make diet changes, you might see improvements in liver health within 3-6 months, though some people may see changes sooner or later depending on their individual situation.

Want to Apply This Research?

  • Track weekly weight changes and monthly liver enzyme levels (ALT and AST) if available from blood tests. Users can log these metrics to visualize progress over 3-6 month periods, which aligns with the study’s timeframe for seeing improvements.
  • Users should focus on logging daily calorie intake to maintain a reduced-calorie diet, as this was the foundation of the study protocol. The app could set a specific calorie reduction goal (typically 500-750 calories below normal intake) and track adherence daily.
  • Establish a 6-month tracking cycle with monthly check-ins. Users should monitor: (1) weight trends, (2) dietary adherence to reduced-calorie goals, (3) liver enzyme results from doctor visits, and (4) any uric acid measurements if available. This long-term approach matches the study duration and helps users see meaningful progress.

This research summary is for educational purposes only and should not be considered medical advice. The study shows mixed results and does not provide strong evidence that allopurinol should be used to treat fatty liver disease. If you have fatty liver disease or are considering allopurinol treatment, consult with your healthcare provider before making any changes to your treatment plan. Your doctor can evaluate your individual situation, medical history, and other medications to determine the best approach for you. Do not start or stop any medications without professional medical guidance.