Does Vitamin E (Vit E) cause steatosis (fatty liver)?

From the Guidelines

Vitamin E does not typically cause fatty liver disease, and in fact, it is sometimes recommended as a treatment for non-alcoholic fatty liver disease (NAFLD), particularly in its more severe form called non-alcoholic steatohepatitis (NASH). According to the most recent and highest quality study, the PIVENS trial, which was a large-scale phase 3 trial, the administration of 96-week high-dose vitamin E (800 IU/day) produced significant improvement in liver histology compared to placebo (43% vs. 19%, P=0.001) 1.

The use of vitamin E can be considered as biopsy-proven NASH treatment in patients without diabetes mellitus, as it decreases oxidative stress and improves liver inflammation 1. However, the long-term use of vitamin E also carries safety concerns because of the increased risk of prostate cancer or hemorrhagic stroke 1.

Some studies have reported that high doses of vitamin E (>400 IU/day) are associated with an increased mortality rate, requiring safety precautions 1. Nevertheless, a retrospective study of 236 patients with biopsy-proven NASH with bridging fibrosis or compensated cirrhosis, the use of 800 IU/day of vitamin E for more than 2 years decreased the risk of death, liver transplantation, and decompensated cirrhosis in patients both with and without diabetes mellitus 1.

It is essential to note that excessive vitamin E supplementation (typically above 1,000 IU daily for extended periods) could potentially cause side effects like increased bleeding risk or slightly increased risk of prostate cancer in men 1. Most people get adequate vitamin E from a balanced diet including nuts, seeds, vegetable oils, and green leafy vegetables.

Anyone considering vitamin E supplements for fatty liver should consult with their healthcare provider first, as treatment needs to be individualized based on the specific cause and severity of their liver condition. The current evidence suggests that vitamin E supplementation can be beneficial for patients with NASH, but it is crucial to weigh the potential benefits against the potential risks and to monitor patients closely for any adverse effects 1.

Key points to consider:

• Vitamin E does not typically cause fatty liver disease
• Vitamin E can be used as a treatment for NASH
• High-dose vitamin E (800 IU/day) can improve liver histology
• Long-term use of vitamin E carries safety concerns
• Excessive vitamin E supplementation can cause side effects
• Treatment should be individualized based on the specific cause and severity of the liver condition.

From the Research

Vitamin E and Fatty Liver Disease

• The relationship between vitamin E and fatty liver disease has been studied in several randomized controlled trials 2, 3, 4, 5, 6.
• These studies suggest that vitamin E may have a beneficial effect on non-alcoholic fatty liver disease (NAFLD) by reducing liver enzymes such as alanine transaminase (ALT) and aspartate aminotransferase (AST) 3, 4, 5.
• Vitamin E has also been shown to improve histological abnormalities in NAFLD, including hepatic steatosis and lobular inflammation 4, 5.
• However, the evidence for the effect of vitamin E on liver fibrosis is less clear, with some studies suggesting that it may not have a significant impact 4, 6.

Potential Benefits of Vitamin E

• Vitamin E may reduce oxidative stress, which plays a major role in the pathogenesis of NAFLD 2, 6.
• Vitamin E supplementation has been shown to improve biochemical and histological parameters in adult patients with NAFLD 5.
• Vitamin E may be a promising choice for the treatment of NAFLD, particularly in patients with non-alcoholic steatohepatitis (NASH) 5, 6.

Limitations and Uncertainties

• The evidence for the effect of vitamin E on NAFLD is largely based on randomized controlled trials with small sample sizes and short follow-up periods 2, 3, 4, 5.
• The optimal dose and duration of vitamin E supplementation for the treatment of NAFLD are unclear 2, 4.
• Further studies are needed to confirm the potential benefits of vitamin E in patients with NAFLD and to determine its long-term safety and efficacy 2, 6.