Vitamin E, specifically in its alpha-tocopherol form, has some scientific support for use in non-alcoholic fatty liver disease (NAFLD), particularly non-alcoholic steatohepatitis (NASH). Several randomized controlled trials, most notably the PIVENS trial (published in NEJM, 2010), have shown that Vitamin E supplementation (800 IU/day of natural alpha-tocopherol) can improve histological features of NASH in non-diabetic adults. The proposed mechanism is due to Vitamin E’s antioxidant properties, which can help reduce oxidative stress and inflammation, both of which are implicated in the pathogenesis of fatty liver disease.

However, the form you mention, alpha-tocopheryl polyethylene glycol succinate (TPGS), is a water-soluble derivative commonly used as a drug delivery enhancer rather than a direct supplement. Most clinical studies supporting Vitamin E use in NAFLD/NASH have used the natural or synthetic alpha-tocopherol, not TPGS specifically. While TPGS does have antioxidant activity and could theoretically confer similar benefits, direct evidence for its use in fatty liver disease is lacking.

Major guidelines (such as AASLD and EASL) recommend Vitamin E supplementation in select non-diabetic adults with biopsy-proven NASH, but not for routine use in all patients with fatty liver. There is insufficient evidence for its use in diabetic patients or those with cirrhosis. Concerns about long-term safety at high doses also persist. In summary, while Vitamin E has some scientific validation for use in certain NAFLD/NASH populations, the evidence is moderate and not specific to TPGS.