Background <p>Several studies have suggested the promising effects of alpha-lipoic acid (ALA) as an antioxidant in patients with nonalcoholic fatty liver disease (NAFLD). However, the results of randomized clinical trials (RCTs) have been contradictory. This meta-analysis examined the effect of ALA supplementation on NAFLD patients.</p> Methods <p>PubMed, Scopus, Web of Science, and the Cochrane Library were systematically searched to include all eligible RCTs published up to February 2026. Weighted mean differences (WMD) with 95% confidence intervals (CI) were used to compare the changes in liver enzymes, obesity measures, lipid profiles, glycemic indices, and adipocytokines between the ALA and placebo groups using a random-effects model.</p> Results <p>Seven RCTs comprising 414 participants were analyzed. In the overall analysis, serum levels of liver enzymes, lipid profiles, glycemic indices, adipocytokines, and obesity measures were not significantly different between the intervention and placebo groups. Moreover, subgroup analyses by age of participants, sample size, baseline body mass index (BMI), method of NAFLD diagnosis, dose of ALA, and duration of follow-up consistently revealed no beneficial effect of ALA on the outcomes. Meta-regression and sensitivity analyses supported the findings.</p> Conclusions <p>The findings indicated that ALA supplementation did not improve liver enzymes, lipid profiles, glycemic indices, adipocytokines, and obesity measures in patients with NAFLD.</p> Clinical trial number <p>Not applicable.</p>