Vitamin E Supplementation Reduces Serum ALT and AST Levels in Subjects with Non-Alcoholic Fatty Liver Disease

by | Oct 5, 2023 | 2023, Liver Health, Vitamin E

Written by Taylor Woosley, Staff Writer. Findings of this systematic review and meta-analysis of 12 RCTs including 1229 participants with NAFLD shows that vitamin E supplementation consistently reduced serum levels of ALT and AST in both pediatric and adult subjects. 

vitamin ENon-alcoholic fatty liver disease (NAFLD) is on the rise globally, with prevalence rates ranging between 23% and 32% depending on geographical region1. NAFLD is an umbrella term for a range of diseases in which steatosis is present in more than 5% of hepatocytes with metabolic risk factors, including type 2 diabetes2. Oxidative stress is increased in NAFLD because of an overproduction of reactive oxygen species (ROS) and a shortage of endogenous antioxidant molecules3.

Vitamin E is a potent lipid-soluble antioxidant that has shown promise in the treatment of NAFLD4. Previous research has shown that vitamin E improves serum transaminases and liver histology in NAFLD5. Other studies show that vitamin E lessens NAFLD though protection of cellular structures against upregulation of superoxide dismutase activity, damage from oxygen free radicals, fibrosis, adiponectin, and leptin expression6.

Vogli et al. conducted a systematic review and meta-analysis to analyze the effect of vitamin E versus a placebo or no interventions in subjects with NAFLD. Study inclusion consisted of randomized controlled trials including subjects diagnosed with NAFLD/NASH, with a vitamin E intervention and a control group that were under placebo, lifestyle modification advice, or were not receiving an intervention, with available data on changes in serum alanine aminotransferase (ALT) and asparate aminotransferase (AST).

12 RCTs with 1229 subjects were included in the final analysis. 10 studies featured subjects in the control group receiving a placebo, and 1 study used a co-intervention of vitamin E with UDCA. 8 studies included adult subjects and four included pediatric participants. Study follow-up periods ranged from 4 to 96 weeks. Subgroup analyses were performed on studies among children or adults as well as for the implication of lifestyle interventions and the duration of studies. Significant findings of the study are as follows:

  • Overall findings show that vitamin E supplementation significantly effected ALT levels [pooled MD = -13.06 IU/L favoring the vitamin E experimental group, 95% CI (-19.17, -6.96), I2 = 94%]. Furthermore, it was associated with reduced AST in the vitamin E experimental group [MD = -6.00 IU/L, (-9.51, -2.48), I2 = 68%].
  • Of the 8 studies with adult participants, vitamin E administration reduced both serum ALT [MD = -7.54 IU/L, 95% CI (-10.21, -4.87), I2 = 44%] and AST [MD = -5.58 IU/L, (-8.72, -2.43), I2 = 60%].
  • The 4 studies including pediatric subjects indicated that vitamin E administration could cause a mean reduction in ALT equal to 22.71 IU/L [(42.13, -3.29), I2 = 98%] and reduced AST levels by 9.95 IU/L [(-26.99, 7.10), I2 = 81%].
  • Studies lasting between 48 and 96 weeks experienced the beneficial impact of vitamin E on both ALT and AST levels [ALT MD = -10.75 IU/L, (-17.15, -4.36), I2 = 32%, and AST MD = -5.83 IU/L, (-10.57, -1.09), I2 = 34%].

Results of the systematic review and meta-analysis of 12 RCTs on the effect of vitamin E on subjects with NAFLD show that vitamin E supplementation can consistently reduce serum ALT and AST levels compared to a placebo. These findings were consistent in both pediatric and adult subjects. Study limitations include the use of different forms of vitamin E in the included studies and the small sample size of the RCTs.

Source: Vogli, Stamatina, Androniki Naska, Georgios Marinos, Maria-Iosifina Kasdagli, and Philippos Orfanos. “The Effect of Vitamin E Supplementation on Serum Aminotransferases in Non-Alcoholic Fatty Liver Disease (NAFLD): A Systematic Review and Meta-Analysis.” Nutrients 15, no. 17 (2023): 3733.

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Click here to read the full text study.

Posted October 5, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Paternostro R, Trauner M. Current treatment of non-alcoholic fatty liver disease. J Intern Med. Aug 2022;292(2):190-204. doi:10.1111/joim.13531
  2. Guo X, Yin X, Liu Z, Wang J. Non-Alcoholic Fatty Liver Disease (NAFLD) Pathogenesis and Natural Products for Prevention and Treatment. Int J Mol Sci. Dec 7 2022;23(24)doi:10.3390/ijms232415489
  3. Ferro D, Baratta F, Pastori D, et al. New Insights into the Pathogenesis of Non-Alcoholic Fatty Liver Disease: Gut-Derived Lipopolysaccharides and Oxidative Stress. Nutrients. Sep 10 2020;12(9)doi:10.3390/nu12092762
  4. Nagashimada M, Ota T. Role of vitamin E in nonalcoholic fatty liver disease. IUBMB Life. Apr 2019;71(4):516-522. doi:10.1002/iub.1991
  5. Poonyam P, Kritsanaviparkporn C, Chommaitree P, Soodcharoen A. The Effects of Combined Vitamin E and C for Treatment of Non-Alcoholic Fatty Liver Disease (NAFLD): A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Asian Pac J Cancer Prev. Sep 1 2022;23(9):2891-2899. doi:10.31557/apjcp.2022.23.9.2891
  6. Karedath J, Javed H, Ahsan Talpur F, et al. Effect of Vitamin E on Clinical Outcomes in Patients With Non-alcoholic Fatty Liver Disease: A Meta-Analysis. Cureus. Dec 2022;14(12):e32764. doi:10.7759/cureus.32764