Protective effects of Ginkgo biloba supplementation on clinical outcomes in metabolic dysfunction-associated steatotic liver disease

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern linked to increased risks of cardiovascular disease, chronic kidney disease (CKD), and premature mortality. Ginkgo biloba has shown potential therapeutic benefits in conditions characterized by metabolic dysfunction. This study aimed to evaluate the potential protective effects of Ginkgo biloba supplementation on overall survival (OS) and the incidence of cardiovascular and renal outcomes specifically in MASLD patients. Methods: This cohort study included 402,476 participants from the UK Biobank, categorized into MASLD and No steatotic liver disease (SLD) cohorts. Ginkgo biloba users and non-users were compared using inverse probability of treatment weighting to balance baseline characteristics. Clinical outcomes were assessed using Cox proportional hazards models, with subgroup analyses. Results: Ginkgo biloba supplementation was associated with significantly improved OS [hazard ratio (HR) = 0.79, 95 % confidence interval (CI): 0.64–0.98, p = 0.034) and reduced risks of cardiovascular events (HR = 0.82, 95 % CI: 0.66–1.00, p = 0.012) and CKD (HR = 0.73, 95 % CI: 0.56–0.96, p = 0.012) in the MASLD cohort, while no significant benefits were observed in the No SLD cohort. Subgroup analyses indicated enhanced benefits in older adults, males, individuals with BMI ≥ 25 kg/m², and diabetic patients. The beneficial effects were pronounced in patients with advanced fibrosis. Conclusion: Ginkgo biloba supplementation is associated with improved survival and reduced cardiovascular and renal risks in MASLD patients, particularly in high-risk subgroups. These findings highlight the potential of Ginkgo biloba as an adjunctive therapy in MASLD management. This is the first large-scale study to examine the potential impact of Ginkgo biloba supplementation on clinical outcomes in MASLD, with fibrosis-stratified analyses providing insights into its differential effects across disease severity.