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Vitamin E improves serum markers and histology in adults with metabolic dysfunction-associated steatotic liver disease: Systematic review and meta-analysis.

  • 2024-08-16
  • Journal of gastroenterology and hepatology 39(12)
    • Nicholas Ming-Zher Chee
    • Ram Prasad Sinnanaidu
    • Wah-Kheong Chan

Study Design

Type
Meta-Analysis
Population
adult patients with MASLD
Methods
systematic literature search on randomized controlled trials; quantitative meta-analysis using SMD, MD, and RR with 95% CI

Background and aim

Multiple clinical trials have been conducted to study the potential benefits of vitamin E for the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD). Despite available evidence, vitamin E is not widely used. This study aimed to assess the effect of vitamin E on serum markers of liver inflammation, specifically serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and histology, including resolution of metabolic dysfunction-associated steatohepatitis (MASH), in adult patients with MASLD.

Methods

A systematic literature search on randomized controlled trials published in English was conducted using electronic databases. Standardized mean difference (SMD) and mean difference (MD) were used for continuous outcomes, while risk ratio (RR) was used for dichotomous outcomes, with corresponding 95% confidence interval (CI).

Results

A total of eight studies were included in the qualitative synthesis while seven studies were included in the meta-analysis. Vitamin E significantly reduced serum ALT and AST levels with SMD of -0.82 (95% CI, -1.13 to -0.51) and -0.68 (95% CI, -0.94 to -0.41), respectively. Vitamin E significantly reduced steatosis, lobular inflammation, and hepatocyte ballooning with a MD of -0.60 (95% CI, -0.83 to -0.37), -0.34 (95% CI, -0.53 to -0.16), -0.32 (95% CI, -0.53 to -0.12), and increased MASH resolution with a RR of 1.9 (95%CI, 1.20 to 3.02). However, vitamin E did not reduce fibrosis, with a MD of -0.23 (95% CI, -0.51 to 0.05).

Conclusion

Vitamin E resulted in significant improvement in serum markers of liver inflammation and histology in patients with MASLD.

Research Insights

  • Vitamin E→Improved MASH Resolution

    increased MASH resolution with a RR of 1.9 (95%CI, 1.20 to 3.02)

    Effect
    Beneficial
    Effect size
    Large
  • Vitamin E→No Change in Fibrosis

    However, vitamin E did not reduce fibrosis, with a MD of -0.23 (95% CI, -0.51 to 0.05).

    Effect
    Neutral
    Effect size
    Small
  • Vitamin E→Reduced ALT Level

    Vitamin E significantly reduced serum ALT and AST levels with SMD of -0.82 (95% CI, -1.13 to -0.51) and -0.68 (95% CI, -0.94 to -0.41), respectively.

    Effect
    Beneficial
    Effect size
    Large
  • Vitamin E→Reduced Aspartate Aminotransferase Level

    Vitamin E significantly reduced serum ALT and AST levels with SMD of -0.82 (95% CI, -1.13 to -0.51) and -0.68 (95% CI, -0.94 to -0.41), respectively.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin E→Reduced Hepatocyte Ballooning

    Vitamin E significantly reduced steatosis, lobular inflammation, and hepatocyte ballooning with a MD of -0.60 (95% CI, -0.83 to -0.37), -0.34 (95% CI, -0.53 to -0.16), -0.32 (95% CI, -0.53 to -0.12)

    Effect
    Beneficial
    Effect size
    Small
  • Vitamin E→Reduced Lobular Inflammation

    Vitamin E significantly reduced steatosis, lobular inflammation, and hepatocyte ballooning with a MD of -0.60 (95% CI, -0.83 to -0.37), -0.34 (95% CI, -0.53 to -0.16), -0.32 (95% CI, -0.53 to -0.12)

    Effect
    Beneficial
    Effect size
    Small
  • Vitamin E→Reduced Steatosis

    Vitamin E significantly reduced steatosis, lobular inflammation, and hepatocyte ballooning with a MD of -0.60 (95% CI, -0.83 to -0.37), -0.34 (95% CI, -0.53 to -0.16), -0.32 (95% CI, -0.53 to -0.12)

    Effect
    Beneficial
    Effect size
    Moderate
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