Vitamin E and nonalcoholic fatty liver disease.
OBJECTIVE
Oxidative stress plays a central role in the transition from simple steatosis to nonalcoholic steatohepatitis (NASH). An effective therapeutic strategy is to target reduction in oxidative stress in NASH patients. The aim of this review is to discuss the role of oxidative stress in NASH and biological activities of vitamin E and present available evidence on the therapeutic efficacy of vitamin E in NASH.


RESULTS
In Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis (PIVENS) trial, vitamin E therapy demonstrated a significant improvement in steatosis, inflammation, ballooning, and resolution of steatohepatitis in adult patients with aggressive NASH, who do not have diabetes or cirrhosis. Although vitamin E showed a significant resolution of NASH in children, a sustained reduction of alanine aminotransferase was not attained in The Treatment of nonalcoholic fatty liver disease (NAFLD) in Children (TONIC) trial.


CONCLUSIONS
The prevalence of NAFLD is likely to increase over time due to the epidemics of obesity and diabetes. Presently, there is no definitive treatment for NAFLD. Based on available evidence, vitamin E (RRR-α-tocopherol) is only recommended in NASH adults without diabetes or cirrhosis and with aggressive histology. Validation is needed in children before its use can be recommended. Longer follow-up of randomized controlled trials are needed to assess long-term vitamin E safety.
Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298-0341, USA. typacana@mcvh-vcu.edu
Tommy
T
Pacana
Arun J
AJ
Sanyal
D000410:Alanine Transaminase / Q000378:metabolism; D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000503:physiopathology; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D005234:Fatty Liver / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D015201:Meta-Analysis as Topic; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D018384:Oxidative Stress / Q000187:drug effects; D000077205:Pioglitazone; D016032:Randomized Controlled Trials as Topic; D045162:Thiazolidinediones / Q000494:pharmacology; D016896:Treatment Outcome; D014810:Vitamin E / Q000502:physiology / Q000627:therapeutic use*
D000975:Antioxidants; D045162:Thiazolidinediones; D014810:Vitamin E; D000410:Alanine Transaminase; D000077205:Pioglitazone