The Role of Vitamin E in the Treatment of NAFLD

doi:10.3390/diseases6040086

Review

. 2018 Sep 24;6(4):86.

doi: 10.3390/diseases6040086.

The Role of Vitamin E in the Treatment of NAFLD

Brandon J Perumpail¹, Andrew A Li², Nimy John³, Sandy Sallam⁴, Neha D Shah⁵, Waiyee Kwong⁶, George Cholankeril⁷, Donghee Kim⁸, Aijaz Ahmed⁹

Affiliations

¹ Drexel University College of Medicine, Philadelphia, PA 19129, USA. brandonperumpail@gmail.com.
² Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. andrewli@stanford.edu.
³ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. nionnj@gmail.com.
⁴ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. SSallam@stanfordhealthcare.org.
⁵ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. NeShah@stanfordhealthcare.org.
⁶ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. WKwong@stanfordhealthcare.org.
⁷ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. georgetc@stanford.edu.
⁸ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. dhkimmd@stanford.edu.
⁹ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. aijazahmed@stanford.edu.

PMID: 30249972
PMCID: PMC6313719
DOI: 10.3390/diseases6040086

Review

The Role of Vitamin E in the Treatment of NAFLD

Brandon J Perumpail et al. Diseases. 2018.

. 2018 Sep 24;6(4):86.

doi: 10.3390/diseases6040086.

Authors

Brandon J Perumpail¹, Andrew A Li², Nimy John³, Sandy Sallam⁴, Neha D Shah⁵, Waiyee Kwong⁶, George Cholankeril⁷, Donghee Kim⁸, Aijaz Ahmed⁹

Affiliations

¹ Drexel University College of Medicine, Philadelphia, PA 19129, USA. brandonperumpail@gmail.com.
² Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. andrewli@stanford.edu.
³ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. nionnj@gmail.com.
⁴ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. SSallam@stanfordhealthcare.org.
⁵ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. NeShah@stanfordhealthcare.org.
⁶ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. WKwong@stanfordhealthcare.org.
⁷ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. georgetc@stanford.edu.
⁸ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. dhkimmd@stanford.edu.
⁹ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA. aijazahmed@stanford.edu.

PMID: 30249972
PMCID: PMC6313719
DOI: 10.3390/diseases6040086

Abstract

There has been a growing interest in the role of vitamin E supplementation in the treatment and/or prevention of nonalcoholic fatty liver (NAFLD). We performed a systematic review of the medical literature from inception through 15 June 2018 by utilizing PubMed and searching for key terms such as NAFLD, vitamin E, alpha-tocopherol, and nonalcoholic steatohepatitis (NASH). Data from studies and medical literature focusing on the role of vitamin E therapy in patients with NAFLD and nonalcoholic steatohepatitis (NASH) were reviewed. Most studies assessing the impact of vitamin E in NAFLD were designed to evaluate patients with NASH with documented biochemical and histological abnormalities. These studies demonstrated improvement in biochemical profiles, with a decline in or normalization of liver enzymes. Furthermore, histological assessment showed favorable outcomes in lobular inflammation and hepatic steatosis following treatment with vitamin E. Current guidelines regarding the use of vitamin E in the setting of NAFLD recommend that vitamin E-based treatment be restricted to biopsy-proven nondiabetic patients with NASH only. However, some concerns have been raised regarding the use of vitamin E in patients with NASH due to its adverse effects profile and lack of significant improvement in hepatic fibrosis. In conclusion, the antioxidant, anti-inflammatory, and anti-apoptotic properties of vitamin E accompanied by ease-of-use and exceptional tolerability have made vitamin E a pragmatic therapeutic choice in non-diabetic patients with histologic evidence of NASH. Future clinical trials with study design to assess vitamin E in combination with other anti-fibrotic agents may yield an additive or synergistic therapeutic effect.

Keywords: NAFLD; NASH; nonalcoholic fatty liver disease; vitamin E alpha-tocopherol.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
The effects of vitamin E in patients with nonalcoholic steatohepatitis (NASH).

**Figure 2**
Summary of vitamins and minerals with nonalcoholic fatty liver disease (NAFLD).

See this image and copyright information in PMC

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References

1. Blond E., Disse E., Cuerq C., Drai J., Valette P.J., Laville M., Thivolet C., Simon C., Caussy C. Easl-easd-easo clinical practice guidelines for the management of non-alcoholic fatty liver disease in severely obese people: Do they lead to over-referral? Diabetologia. 2017;60:1218–1222. doi: 10.1007/s00125-017-4264-9. - DOI - PubMed
1. Chalasani N., Younossi Z., Lavine J.E., Diehl A.M., Brunt E.M., Cusi K., Charlton M., Sanyal A.J. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the american gastroenterological association, american association for the study of liver diseases, and american college of gastroenterology. Gastroenterology. 2012;142:1592–1609. doi: 10.1053/j.gastro.2012.04.001. - DOI - PubMed
1. Oseini A.M., Sanyal A.J. Therapies in non-alcoholic steatohepatitis (nash) Liver Int. 2017;37:97–103. doi: 10.1111/liv.13302. - DOI - PMC - PubMed
1. Liu Z., Ren Z., Zhang J., Chuang C.C., Kandaswamy E., Zhou T., Zuo L. Role of ros and nutritional antioxidants in human diseases. Front. Physiol. 2018;9:477. doi: 10.3389/fphys.2018.00477. - DOI - PMC - PubMed
1. Li L., Yang X. The essential element manganese, oxidative stress, and metabolic diseases: Links and interactions. Oxid. Med. Cell. Longev. 2018;2018:7580707. doi: 10.1155/2018/7580707. - DOI - PMC - PubMed

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[1] Blond E., Disse E., Cuerq C., Drai J., Valette P.J., Laville M., Thivolet C., Simon C., Caussy C. Easl-easd-easo clinical practice guidelines for the management of non-alcoholic fatty liver disease in severely obese people: Do they lead to over-referral? Diabetologia. 2017;60:1218–1222. doi: 10.1007/s00125-017-4264-9. - DOI - PubMed

[2] Blond E., Disse E., Cuerq C., Drai J., Valette P.J., Laville M., Thivolet C., Simon C., Caussy C. Easl-easd-easo clinical practice guidelines for the management of non-alcoholic fatty liver disease in severely obese people: Do they lead to over-referral? Diabetologia. 2017;60:1218–1222. doi: 10.1007/s00125-017-4264-9. - DOI - PubMed

[3] Chalasani N., Younossi Z., Lavine J.E., Diehl A.M., Brunt E.M., Cusi K., Charlton M., Sanyal A.J. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the american gastroenterological association, american association for the study of liver diseases, and american college of gastroenterology. Gastroenterology. 2012;142:1592–1609. doi: 10.1053/j.gastro.2012.04.001. - DOI - PubMed

[4] Chalasani N., Younossi Z., Lavine J.E., Diehl A.M., Brunt E.M., Cusi K., Charlton M., Sanyal A.J. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the american gastroenterological association, american association for the study of liver diseases, and american college of gastroenterology. Gastroenterology. 2012;142:1592–1609. doi: 10.1053/j.gastro.2012.04.001. - DOI - PubMed

[5] Oseini A.M., Sanyal A.J. Therapies in non-alcoholic steatohepatitis (nash) Liver Int. 2017;37:97–103. doi: 10.1111/liv.13302. - DOI - PMC - PubMed

[6] Oseini A.M., Sanyal A.J. Therapies in non-alcoholic steatohepatitis (nash) Liver Int. 2017;37:97–103. doi: 10.1111/liv.13302. - DOI - PMC - PubMed

[7] Liu Z., Ren Z., Zhang J., Chuang C.C., Kandaswamy E., Zhou T., Zuo L. Role of ros and nutritional antioxidants in human diseases. Front. Physiol. 2018;9:477. doi: 10.3389/fphys.2018.00477. - DOI - PMC - PubMed

[8] Liu Z., Ren Z., Zhang J., Chuang C.C., Kandaswamy E., Zhou T., Zuo L. Role of ros and nutritional antioxidants in human diseases. Front. Physiol. 2018;9:477. doi: 10.3389/fphys.2018.00477. - DOI - PMC - PubMed

[9] Li L., Yang X. The essential element manganese, oxidative stress, and metabolic diseases: Links and interactions. Oxid. Med. Cell. Longev. 2018;2018:7580707. doi: 10.1155/2018/7580707. - DOI - PMC - PubMed

[10] Li L., Yang X. The essential element manganese, oxidative stress, and metabolic diseases: Links and interactions. Oxid. Med. Cell. Longev. 2018;2018:7580707. doi: 10.1155/2018/7580707. - DOI - PMC - PubMed

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The Role of Vitamin E in the Treatment of NAFLD

Affiliations

The Role of Vitamin E in the Treatment of NAFLD

Authors

Affiliations

Abstract

Conflict of interest statement

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