Vitamin E Intake Improves Fatty Liver Disease

NEW YORKVitamin E has been shown effective in treating nonalcoholic steatohepatitis (NASH), an obesity-associated chronic liver disease that can lead to cirrhosis, liver cancer and death, according to a new study published in the New England Journal of Medicine. NASH also is related to or a part of type 2 diabetes, lipid disorders and cardiovascular disease.

"There is an increasing prevalence of nonalcoholic steatohepatitis in this country, something that is directly related to the obesity epidemic," said Dr. Joel Lavine, co-chair of the Network's steering committee and a co-author of the study. "The good news is that this study showed that cheap and readily available vitamin E can help many of those with the condition. We also looked at the drug pioglitazone, which showed some benefits, although not as dramatic as with vitamin E."

In the Pioglitazone or Vitamin E for NASH Study (PIVENS), investigators randomly assigned 247 nondiabetic adults with biopsy-confirmed NASH to receive vitamin E, pioglitazone or placebo. Vitamin E functions as an antioxidant while pioglitazone improves the sensitivity of cells to insulin, a hormone that controls both sugar and fat metabolism.

After 96 weeks of treatment, vitamin E improved all features of NASH with the exception of the amount of scar tissue in the liver; 43 percent of those treated with vitamin E met the primary endpoint of the trial, which was a composite of the scores for several features of NASH indicative of disease activity, compared with only 19 percent of those who received a placebo. Pioglitazone also improved many features of NASH and met the primary endpoint in 34 percent of individuals who received it but fell short of statistical significance. Pioglitazone treatment led to an average weight gain of 10 pounds over the 96-week duration of the study. Liver enzyme tests also improved in those who received either pioglitazone or vitamin E. Upon stopping the medications, the liver enzymes worsened again suggesting the need for long-term treatment.