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Vitamin E in Nonalcoholic Fatty Liver Disease

  • Bubu A. Banini
  • Arun J. SanyalEmail author
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide, accounting for over 100 billion dollars in annual direct medical costs in the United States alone. Nonalcoholic steatohepatitis (NASH) is a subtype of NAFLD that can progress to cirrhosis and liver cancer. To date, there are no approved pharmacological therapies for NASH. Vitamin E is an antioxidant that has been shown to improve the histological features of NASH in both preclinical and clinical studies. Several clinical practice guidelines recommend vitamin E as off-label treatment for NASH. Here, we discuss the complex pathogenesis of NASH, with emphasis on oxidative stress and organelle dysfunction. We summarize evidence supporting the beneficial role of vitamin E supplementation on NASH and on liver fibrosis, based on studies in animal models of NAFLD, in clinical trials of NAFLD patients and in meta-analyses. We briefly highlight the use of vitamin E in other forms of chronic liver disease, including alcoholic liver disease and chronic viral hepatitis, where the role of vitamin E supplementation remains controversial. Finally, we discuss safety concerns related to the long-term use of vitamin E and suggest that risks and benefits be discussed with patients prior to initiating vitamin E supplementation.

Keywords

α-tocopherol Metabolic syndrome Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Oxidative stress PIVENS trial TONIC trial Vitamin E 

Abbreviations

4-HNE

4-Hydroxy-2-nonenal

8-OHdG

8-Hydroxy-2′-deoxyguanosine

ALT

Alanine aminotransferase

CRN

Clinical Research Network

CYP2E1

Cytochrome P450 2E1

ER

Endoplasmic reticulum

FAD

Flavin adenine dinucleotide

FFA

Free fatty acids

GPx

Glutathione peroxidase

GSH

Glutathione

IR

Insulin resistance

JNK

Janus kinase

MCD

Methionine-choline-deficient

MDA

Malondialdehyde

MRC

Mitochondrial respiratory complex

NAD

Nicotinamide adenine dinucleotide

NAFL

Nonalcoholic fatty liver

NAFLD

Nonalcoholic fatty liver disease

NASH

Nonalcoholic steatohepatitis

PIVENS

Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis

PPAR-α

Peroxisome proliferator-activated receptor-α

PUFAs

Polyunsaturated fatty acids

RCT

Randomized control trial

ROS

Reactive oxygen species

SELECT

Selenium and Vitamin E Cancer Prevention Trial

SH3BP5

SH3 domain-binding protein 5

TNF

Tumor necrosis factor

TONIC

Treatment of nonalcoholic fatty liver disease in Children

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Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology and Nutrition, Department of Internal MedicineVirginia Commonwealth UniversityRichmondUSA

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