Vitamin E and Vitamin C Beneficial in Fatty Liver Disease
Healthnotes Newswire (February 12, 2004)Supplementing with vitamins E and
C may improve liver fibrosis in people with nonalcoholic steatohepatitis
(NASH), according to a new study in The American Journal of
NASH is an advanced form of a group of conditions collectively referred to
as nonalcoholic fatty liver disease. Nonalcoholic fatty liver disease is
usually not life threatening; however, in some cases the NASH form may lead
to the progressive formation of abnormal fibrous tissue in the liver
(fibrosis), eventually culminating in generally irreversible liver damage
(cirrhosis of the liver), liver failure, or liver cancer. NASH is often
associated with obesity, high blood levels of fats (called lipids),
diabetes, and high blood pressure.
Although the disease process is not completely understood, some factors are
thought to contribute to the development of NASH. These include insulin
resistance (the reduced ability of the body to respond to circulating
levels of insulin); free-radical damage to fatty acids in the body, leading
to inflammation and eventual tissue death and liver fibrosis; and dietary
habits that cause blood fats to accumulate in the liver. Since there is no
cure for NASH, most treatment plans are aimed at reducing the risk factors.
Current recommendations may include lipid regulation (reduction of blood
fats by dietary changes, nutritional supplementation, or lipid-lowering
medications), gradual weight loss, insulin sensitizers (agents that enhance
the body's response to insulin), and supplementation with antioxidants. New
drugs are also being investigated.
This study was designed to determine the response of various parameters of
liver health in people with NASH when treated with the antioxidant vitamins
E and C. Specifically, liver inflammation and tissue death (necrosis),
liver fibrosis, and liver enzymes (a measure of liver inflammation) were
assessed. People with a diagnosis of NASH were randomly assigned to take
either (1) vitamin E (1,000 IU) and vitamin C (1,000 mg) or (2) placebo
every day for six months. Both groups were encouraged to follow a
weight-loss program and to consume less than 30 grams of fat per day. The
vitamin group participants had a higher incidence of diabetes than the
placebo group. Liver biopsies were performed pre- and post-treatment. No
significant side effects were noted in the 45 people who completed the
At the end of the six-month period, there was a small, yet statistically
significant improvement in fibrosis scores in the vitamin group but not the
placebo group. No difference was noted in the inflammation or necrosis
scores between the groups. In general, there was a trend toward more
improvement in fibrosis scores in those people with more severe fibrosis.
Among non-diabetic participants, there was no significant change in
fibrosis during the study in either group. Diabetics receiving vitamins E
and C were found to have the most initial fibrosis and subsequently the
most improvement in fibrosis during the study period.
These results seem to indicate more benefit in diabetics with more severe
fibrosis. However, because the number of diabetics in the vitamin group was
not matched in the placebo group it cannot be said with certainty that
people with NASH who take vitamins E and C will benefit. Further studies
are needed to investigate the usefulness of vitamin E and C supplementation
in people with NASH and to confirm the finding of selective improvement in
diabetics with more severe fibrosis. Little or no change was seen in the
level of liver enzymes during the study.
Previous preliminary studies have reported similar findings of reduced
liver inflammation and fibrosis and lowered liver enzymes following
treatment with vitamin E.
NASH may be best treated using a multifaceted approach aimed at addressing
the underlying causes and preventing further damage. The results of this
study are promising, as fibrosis scores actually improved over the study
period. Since the amount of fibrosis is more predictive of disease severity
than liver enzyme levels, an improvement in fibrosis may translate to a
decreased likelihood of progression to cirrhosis and liver failure.
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