Vitamin E supplementation in the treatment on nonalcoholic fatty liver disease (NAFLD): Evidence from an umbrella review of meta‐analysis on randomized controlled trials

Abstract

ObjectiveThe impact of vitamin E supplementation on liver biomarkers in NAFLD patients remains controversial. Therefore, we conducted the present umbrella meta‐analysis of randomized controlled trials to clarify the effects of vitamin E administration on alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma‐glutamyl transferase (GGT), steatosis levels and fibrosis score in individuals diagnosed with NAFLD.MethodsFour databases (PubMed/MEDLINE, Scopus, EMBASE, and Web of Science) were searched to identify pertinent papers published in international scientific journals from the inception of these search services and up to June 2023. To calculate the overall effect size (ES) and confidence intervals (CI), we applied the random‐effects model.ResultsIn total, 6 meta‐analyses were included in the umbrella meta‐analysis. By pooling ES based on the random‐effects model, we discovered that vitamin E supplementation significantly decreased ALT (ES = −6.47 U/L; 95% CI: −11.72, −1.21, P = 0.01), AST (ES = −5.35 U/L; 95% CI: −9.78, −0.92, P = 0.01), fibrosis score (ES = −0.24 U/L; 95% CI: −0.36, −0.11, P < 0.001), and steatosis levels (ES = −0.66; 95% CI: −0.88, −0.45, P < 0.001) but had no effect on GGT values in NAFLD patients. In the subgroup analyses, we detected that fibrosis scores notably decreased when vitamin E dosage was >500 IU/day (ES = −0.25; 95% CI: −0.40, −0.09, P = 0.002) and when the treatment duration was >20 months (ES = −0.26; 95% CI: −0.47, −0.063, P = 0.01).ConclusionsVitamin E administration reduces ALT, AST, fibrosis and steatosis levels in NAFLD subjects. Fibrosis scores are significantly reduced when vitamin E dose exceeds 500 IU/day and treatment duration surpasses 20 months.This article is protected by copyright. All rights reserved.

Integrated traditional Chinese and Western medicine in the prevention and treatment of non-alcoholic fatty liver disease: future directions and strategies

“…Furthermore, genetic factors, including variations in haptoglobin and fatty acid desaturase 1/2 (FADS1/FADS2), may influence the therapeutic efficacy of Vitamin E in NAFLD [ 114 ]. Clinical studies have demonstrated Vitamin E ameliorates liver fibrosis in patients with NASH [ 115 ]. Additionally, a combination treatment of vitamin E and hydroxytyrosol has been shown to inhibit hepatic stellate cell proliferation by disrupting the nuclear translocation/activation of SMAD2/3 transcription factors, thereby improving NAFLD-related fibrosis in children [ 116 ].…”

MASLD treatment—a shift in the paradigm is imminent

“…Indeed, there is limited evidence from some observational studies and 2 out of 4 randomized controlled trials suggesting a mild increase in the risk for hemorrhagic stroke and a possible decreased risk in ischemic stroke ( 121 ), which was attributed to its antiplatelet actions ( 124 ). Subsequently, 3 meta-analyses of smaller studies on vitamin E, suggest not only a benefit in steatosis and inflammation, as well as in liver fibrosis ( 125–127 ), particularly for doses higher than 500 IU per day, for longer than 20 months ( 127 ). Lastly, a retrospective study that evaluated 180 patients with MASH and advanced fibrosis (F3 or F4) treated with vitamin E 800 IU/day for longer than 2 years, as compared with 90 propensity-matched controls, showed vitamin E to be associated with an increased transplant-free survival (90% vs. 78% at 10 years, with a number needed to treat, NNT, of just 4.28) and decreased rates of hepatic decompensation (37% vs. 62% at 10 years, with a NNT 6.43) ( 128 ).…”