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Efficacy and Safety of Vitamin E in Adults With Metabolic Dysfunction-Associated Steatohepatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

  • 2025-07-29
  • Cureus 17(7)
    • Helai Hussaini
    • Manpreet Kaur Dhanjal
    • Rahman Hameed Mohammed Abdul
    • Olaniyi Fadeyi
    • Najeeha A Bhatti
    • Mohammed Qasim Rauf
    • Calvin R Wei
    • Adil Amin

Study Design

Type
Review
Population
adults with metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH)
Methods
Systematic review and meta-analysis of randomized controlled trials comparing vitamin E versus placebo in MASH patients. Comprehensive search of PubMed, Cochrane Library, Embase, and Scopus from inception to May 25, 2025. Three high-quality RCTs included.
This systematic review and meta-analysis evaluated the efficacy and safety of vitamin E supplementation in adults with metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH). A comprehensive search of PubMed, Cochrane Library, Embase, and Scopus databases was conducted from inception to May 25, 2025, identifying randomized controlled trials comparing vitamin E versus placebo in MASH patients. After screening 752 records, three high-quality randomized controlled trials were included in the final analysis. The pooled analysis demonstrated that vitamin E significantly reduced serum alanine aminotransferase levels compared to placebo (mean difference (MD): -12.27, 95% confidence interval (CI): -16.66 to -7.89) and aspartate aminotransferase levels (MD: -7.08; 95% CI: -14.93 to 0.76). Vitamin E was associated with significantly higher odds of fibrosis improvement (odds ratio (OR): 1.96, 95% CI: 1.25-3.09) with no heterogeneity observed across studies. However, MASH resolution showed no statistically significant difference between groups (OR: 1.71, 95% CI: 0.69-4.27) with substantial heterogeneity, though sensitivity analysis excluding one study revealed a significant benefit. The studies varied in vitamin E dosing from 300 to 800 mg daily, with two conducted in the United States and one in China. These findings suggest that vitamin E supplementation provides biochemical and histological benefits in MASH patients, particularly in reducing liver enzyme levels and improving fibrosis. However, the limited number of trials and varying outcome definitions highlight the need for larger, standardized multinational studies to establish optimal dosing recommendations and long-term safety profiles.

Research Insights

  • Vitamin E→Improved Fibrosis

    Vitamin E was associated with significantly higher odds of fibrosis improvement (odds ratio (OR): 1.96, 95% CI: 1.25-3.09)

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    300 to 800 mg daily
  • Vitamin E→Improved MASH Resolution

    MASH resolution showed no statistically significant difference between groups (OR: 1.71, 95% CI: 0.69-4.27)

    Effect
    Neutral
    Effect size
    Small
    Dose
    300 to 800 mg daily
  • Vitamin E→Reduced Alanine Aminotransferase Level

    vitamin E significantly reduced serum alanine aminotransferase levels compared to placebo (mean difference (MD): -12.27, 95% confidence interval (CI): -16.66 to -7.89)

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    300 to 800 mg daily
  • Vitamin E→Reduced Aspartate Aminotransferase Levels

    aspartate aminotransferase levels (MD: -7.08; 95% CI: -14.93 to 0.76)

    Effect
    Neutral
    Effect size
    Small
    Dose
    300 to 800 mg daily
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