title: Management of fatty liver disease with vitamin E and C compared to ursodeoxycholic acid treatment.
abstract: OBJECTIVE
  Despite a proposed role of oxidative stress in the pathogenesis of nonalcoholic steatohepatitis, antioxidant approaches have not been investigated sufficiently in the therapy of nonalcoholic steatohepatitis. Our aim was to determine whether vitamin E plus C therapy is effective in normalization of liver enzymes compared to ursodeoxycholic acid treatment in patients with fatty liver disease.
  
  
  METHODS
  This was an open-labeled, prospective, randomized study enrolling patients with histologically proven fatty liver disease who had chronically elevated alanine aminotransferase, despite a three-month reducing diet. Patients consuming alcohol (more than 20 g/day) were excluded. The patients were randomly prescribed either oral vitamin E (600 IU/day) plus vitamin C (500 mg/day) or ursodeoxycholic acid (10 mg/kg/day). Patients were randomized as two groups to receive vitamin E plus vitamin C combination (28 patients, 10 F) or ursodeoxycholic acid treatment (29 patients, 13 F).
  
  
  RESULTS
  There was no significant change in body mass index before and after the treatment in both groups. At the end of six months of therapy, serum aspartate aminotransferase and aminotransferase levels significantly decreased in both treatment options. Vitamin E and C combination was more efficacious on serum aminotransferase levels than ursodeoxycholic acid, but the difference was not significant. Alanine aminotransferase decreased to normal levels in 17 of 27 (63%) and in 16 of 29 patients (55%), respectively, in the two groups. Gamma-glutamyl transpeptidase decreased in patients receiving ursodeoxycholic acid, but no change was obtained in the vitamin-treated patients.
  
  
  CONCLUSIONS
  Vitamin E plus C combination treatment is a safe, inexpensive and effective treatment option in patients with fatty liver disease, with results comparable to those obtained with ursodeoxycholic acid. Since more effective new therapeutic options are lacking, patients with fatty liver disease should be encouraged to take vitamin E and C supplements, which are safe and affordable.
authors.affiliation: Department of Gastroenterology, Ege University Medical School, Izmir, Turkey.
authors.forename: Galip
authors.initials: G
authors.lastname: Ersöz
authors.forename: Fulya
authors.initials: F
authors.lastname: Günşar
authors.forename: Zeki
authors.initials: Z
authors.lastname: Karasu
authors.forename: Sinan
authors.initials: S
authors.lastname: Akay
authors.forename: Yücel
authors.initials: Y
authors.lastname: Batur
authors.forename: Ulus Salih
authors.initials: US
authors.lastname: Akarca
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood / Q000187:drug effects; D000469:Alkaline Phosphatase / Q000097:blood / Q000187:drug effects; D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D002756:Cholagogues and Choleretics / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000201:enzymology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D014810:Vitamin E / Q000627:therapeutic use*; D005723:gamma-Glutamyltransferase / Q000097:blood / Q000187:drug effects
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D002756:Cholagogues and Choleretics; D014810:Vitamin E; D014580:Ursodeoxycholic Acid; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001205:Ascorbic Acid