Do symbiotic and Vitamin E supplementation have favorite effects in nonalcoholic fatty liver disease? A randomized, double-blind, placebo-controlled trial

Ekhlasi, Golnaz; Mohammadi, Roya Kolahdouz; Agah, Shahram; Zarrati, Mitra; Hosseini, Agha Fatemeh; Arabshahi, Seyed Soroush Soltani; Shidfar, Farzad

doi:10.4103/1735-1995.193178

Cited by 40 publications

(24 citation statements)

References 42 publications

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“…Intriguingly, the effects of this symbiotic on NAFLD have also been recently evaluated in three additional pilot RCTs with conflicting results [ 110 , 111 , 112 ]. Thus, in a study carried out with 74 overweight and obese volunteers who did not undergo dietary and physical exercise programmes, one capsule per day of this multi-ingredient significantly decreased the severity of hepatic steatosis (analysed by ultrasonography) 8 weeks after the beginning of the treatment, fully counteracting this alteration in 50% and 25% of the participants who showed a mild and moderate degree of NAFLD at baseline, respectively [ 110 ].…”

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

“…Although this attenuation of fatty liver was only weakly observed in the group that received the placebo, when a direct comparison between both groups was performed, no significant changes were reported in this parameter at the end of the treatment period, and the synbiotic did not produce a significant decrease in the circulating levels of ALT, AST or CRP [ 110 ]. In another study conducted with 60 adult overweight and obese participants with NAFLD diagnosed by hepatic ultrasonography and elevated levels of ALT, Ekhlasi and co-workers analysed whether daily supplementation with this multi-ingredient (two capsules per day) plus vitamin E (400 IU/day) for 8 weeks strengthened the effects produced by the synbiotic or the vitamin E when they were administered separately [ 111 , 112 ]. Although the volunteers were not subjected to a lifestyle modification programme, the authors found that both the synbiotic and the symbiotic plus vitamin E produced a similar decrease in systolic blood pressure (SBP) and the circulating levels of TAGs and total cholesterol [ 111 , 112 ].…”

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

“…In another study conducted with 60 adult overweight and obese participants with NAFLD diagnosed by hepatic ultrasonography and elevated levels of ALT, Ekhlasi and co-workers analysed whether daily supplementation with this multi-ingredient (two capsules per day) plus vitamin E (400 IU/day) for 8 weeks strengthened the effects produced by the synbiotic or the vitamin E when they were administered separately [ 111 , 112 ]. Although the volunteers were not subjected to a lifestyle modification programme, the authors found that both the synbiotic and the symbiotic plus vitamin E produced a similar decrease in systolic blood pressure (SBP) and the circulating levels of TAGs and total cholesterol [ 111 , 112 ]. However, in comparison to the placebo group, the combined administration of symbiotic and vitamin E produced a greater drop in the circulating levels of LDL-C, TNFα, ALT, AST, ALP, leptin, insulin and glucose than supplementation of the symbiotic alone [ 111 , 112 ].…”

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

“…Although the volunteers were not subjected to a lifestyle modification programme, the authors found that both the synbiotic and the symbiotic plus vitamin E produced a similar decrease in systolic blood pressure (SBP) and the circulating levels of TAGs and total cholesterol [ 111 , 112 ]. However, in comparison to the placebo group, the combined administration of symbiotic and vitamin E produced a greater drop in the circulating levels of LDL-C, TNFα, ALT, AST, ALP, leptin, insulin and glucose than supplementation of the symbiotic alone [ 111 , 112 ]. These results suggested that the synbiotic plus vitamin E was generally the most effective treatment in lowering parameters closely related to the pathogenesis of NAFLD [ 111 , 112 ].…”

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

“…However, in comparison to the placebo group, the combined administration of symbiotic and vitamin E produced a greater drop in the circulating levels of LDL-C, TNFα, ALT, AST, ALP, leptin, insulin and glucose than supplementation of the symbiotic alone [ 111 , 112 ]. These results suggested that the synbiotic plus vitamin E was generally the most effective treatment in lowering parameters closely related to the pathogenesis of NAFLD [ 111 , 112 ]. Nevertheless, the authors did not analyse the effects of the different treatments on hepatic steatosis by ultrasonography or liver biopsy; therefore, further RCTs are needed to elucidate whether the supplementation of the symbiotic plus vitamin E is more effective that treatment with the symbiotic alone against NAFLD [ 111 , 112 ].…”

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

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Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease

et al. 2017

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Non-alcoholic fatty liver disease (NAFLD) comprises a wide spectrum of hepatic disorders, from simple steatosis to hepatic necro-inflammation leading to non-alcoholic steatohepatitis (NASH). Although the prevalence of these multifactorial pathologies is continuously increasing in the population, there is still not an established methodology for their treatment other than weight loss and a change in lifestyle habits, such as a hypocaloric diet and physical exercise. In this framework, there is increasing evidence that several food bioactives and dietary patterns are effective for reversing and preventing the onset of these pathologies. Some studies have claimed that better responses are obtained when treatments are performed under a multifaceted approach, using different bioactive compounds that act against complementary targets. Thus, in this work, current strategies for treating NAFLD and NASH based on multi-ingredient-based supplements or the Mediterranean diet, a dietary pattern rich in bioactive compounds, are reviewed. Furthermore, the usefulness of omics techniques to design effective multi-ingredient nutritional interventions and to predict and monitor their response against these disorders is also discussed.

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Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

Section: Multi-ingredient Nutritional Approaches For the Treatmentmentioning

confidence: 99%

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Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease

et al. 2017

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Nutritional supplementation for nonalcohol-related fatty liver disease: a network meta-analysis

Komolafe

Buzzetti

Linden

et al. 2021

Cochrane Database of Systematic Reviews

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Vitamin E for people with non-alcoholic fatty liver disease

Wen,

Deng,

Yang

et al. 2024

Cochrane Database of Systematic Reviews

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Rationale Non‐alcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction‐associated steatotic liver disease (MASLD), is the most common liver disease worldwide, affecting an estimated 3 in 10 people. The available treatment is far from optimal. Diet and lifestyle changes to promote weight loss and weight loss maintenance are the basic management of NAFLD, but these are difficult to achieve and maintain. Vitamin E has shown beneficial effects on oxidative stress, which plays a major role in the pathogenesis of NAFLD. However, there is uncertainty about the effects of vitamin E for people with NAFLD. Objectives To evaluate the beneficial and harmful effects of vitamin E alone, or vitamin E in combination with other vitamins or minerals, versus placebo or no intervention in people with NAFLD. Search methods We used recommended Cochrane search methods. The latest search was performed on 2 February 2024. Eligibility criteria We included randomised clinical trials that compared vitamin E alone, or in combination with other vitamins or minerals, at any dose, duration, and route of administration, versus placebo or no intervention, in people with NAFLD of any age, sex, or ethnic origin. We included participants with imaging techniques or histology‐proven NAFLD and minimal alcohol intake, and participants with steatohepatitis who had liver biopsies. Outcomes Our critical outcomes were all‐cause mortality, liver‐related mortality, and serious adverse events. Our important outcomes were liver‐related morbidity, health‐related quality of life, non‐serious adverse events, biochemical response, and imaging assessment of the degree of fatty liver. Risk of bias We used Cochrane's RoB 2 tool to assess risk of bias for each of the predefined outcomes. Synthesis methods We used standard Cochrane methods. We used GRADE to assess the certainty of evidence. Included studies We included 16 randomised clinical trials involving 1066 paediatric and adult participants with NAFLD. Experimental groups received vitamin E alone (14 trials) or vitamin E in combination with vitamin C (2 trials). Control groups received placebo in 13 trials and no intervention in three trials. Daily dosages of oral vitamin E ranged from 298 international units (IU) to 1000 IU. Co‐interventions were lifestyle and low‐calorie diet interventions in 13 trials, ursodeoxycholic acid in one trial, unchanged diet and physical activity in one trial, and baseline treatments for type 2 diabetes in one trial. Nine trials had more than two intervention groups, but we used only the groups in which vitamin E alone or vitamin E in combination with vitamin C were compared with placebo or no intervention. In total, 7.9% (84/1066) of participants dropped out. Follow‐up ranged from 2 months to 24 months. Synthesis of...

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Do symbiotic and Vitamin E supplementation have favorite effects in nonalcoholic fatty liver disease? A randomized, double-blind, placebo-controlled trial

Cited by 40 publications

References 42 publications

Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease

Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease

Nutritional supplementation for nonalcohol-related fatty liver disease: a network meta-analysis

Vitamin E for people with non-alcoholic fatty liver disease

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