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Vitamin E lowers mortality, transplant rates in patients with NASH

Vitamin E supplementation correlated with lower rates of all-cause mortality, liver transplantation and development of hepatic decompensation in patients with nonalcoholic steatohepatitis and advanced fibrosis, according to a study published in Hepatology.

“Beyond of antioxidant effects, vitamin E has also been implicated in the regulation of inflammatory response via several enzymes involved in signal transduction as well as expression of specific genes closely related to inflammatory pathways, cellular trafficking and proliferation,” Eduardo Vilar-Gomez, MD, PhD, from the Indiana University School of Medicine, and colleagues wrote.

Vilar-Gomez and colleagues enrolled patients with NASH and bridging fibrosis or compensated cirrhosis and matched 90 patients who received vitamin E with 90 controls. Treated patients received 800 IU per day of vitamin E for 2 years or more.

Vitamin E demonstrated significant protection against overall mortality or need for transplantation after controlling by fibrosis severity (HR = 0.3; 95% CI, 0.12-0.74), MELD score (HR = 0.34; 95% CI, 0.14-0.85) and liver function tests (HR = 0.41; 95% CI, 0.18-0.94) compared with controls.

“Epidemiological studies have reported that low plasma levels of vitamin E are not only associated with presence of NASH but also with increased all-cause mortality among NAFLD patients,” the researchers wrote.

The proportion of patients who developed an initial hepatic decompensation event during follow-up was significantly lower among patients treated with vitamin E compared with controls (37% vs. 62%; P = .044).

Patients treated with vitamin E also had a reduced risk for hepatic decompensation compared with controls after adjusting for fibrosis severity (HR = 0.52; 95% CI, 0.28-0.96), MELD score (HR = 0.53; 95% CI, 0.29-0.98) and liver function tests (HR = 0.55; 95% CI, 0.3-0.98).

“Our data also suggest that benefits of taking vitamin E can be extended to diabetic patients with biopsy-proven NASH and advanced fibrosis,” the researchers wrote.

Vitamin E significantly reduced the risk for all-cause mortality or transplantation among both patients with diabetes (adjusted HR = 0.29; 95% CI, 0.11-0.76) and those without diabetes (aHR = 0.19; 95% CI, 0.05-0.74) after adjusting for fibrosis severity.

“Although it is reassuring that we did not observe any safety signals associated with long term high dose vitamin E use, our study is very underpowered for detecting rare adverse events,” Vilar-Gomez and colleagues concluded. “These data urgently call for a randomized, double-blind, placebo-controlled trial to confirm these preliminary and yet very promising results.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.