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Background: The hepatoprotective effects of silymarin have been confirmed by various researchers worldwide; however few studies are available about the therapeutic impact of silymarin on the level of aminotransferases in patients nonalcoholic steatohepatitis (NASH). Our purpose is to determine whether silymarin improves the serum level aminotransferases in patients with NASH. Materials and Methods: This was a double blind, randomized, placebo-controlled trial performed on 100 patients with NASH. Subjects were randomized to receive silymarin (140 mg/ql2h) for three months or placebo, given in the same manner. A blood sample was drawn at baseline (before treatment) and after completion of the treatment schedule to assess serum aminotransferase levels. We measured body mass index (BMI) before and after administration of the treatments for both groups of patients. Results: There were insignificant changes in BMI for both groups. The mean serum alanine aminotransferase (ALT) level in the case group significantly changed from 84.06 to 68.54 IU/mL following treatment with silymarin (p<0.001) however this change was not significant in the control group. The mean serum aspartate aminotransferase (AST) level in the case group significantly decreased from 71.94 to 54.70 1U/mL after treatment with silymarin. This change in the placebo group was not significant (from 62.94 to 61.56 IU/mL). Conclusion: Administration of silymarin can effectively reduce liver aminotransferases without any changes in BMI in patients with NASH disease. [ABSTRACT FROM AUTHOR]