Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Vitamin E, particularly in the form of alpha-tocopherol, has been studied as a treatment for nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH). The rationale for its use stems from its antioxidant properties, as oxidative stress is believed to play a significant role in the progression of fatty liver disease. Clinical trials such as the PIVENS trial (Sanyal et al., NEJM, 2010) demonstrated that vitamin E at a dose of 800 IU/day improved liver histology in non-diabetic adults with NASH compared to placebo. This led to recommendations by some guidelines (e.g., AASLD 2018) for considering vitamin E as a treatment option in non-diabetic adults with biopsy-proven NASH. However, the evidence for vitamin E's benefit in simple steatosis (fatty liver without inflammation) or in diabetic patients is less robust or inconclusive. Most studies have used alpha-tocopherol, and there is limited direct evidence for mixed tocotrienols/tocopherols, though they share antioxidant activity. Potential concerns include the safety of long-term high-dose vitamin E supplementation, as some meta-analyses have suggested an increased risk of all-cause mortality at high doses, though this remains debated. In summary, there is moderate-quality scientific evidence supporting the use of vitamin E (mainly alpha-tocopherol) in specific subgroups of fatty liver disease, namely non-diabetic NASH, but not universally or for mixed tocotrienols/tocopherols specifically.

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