Vitamin E improves transplant-free survival and hepatic decompensation among patients with nonalcoholic steatohepatitis and advanced fibrosis
Open accessAbstract
Vitamin E improves liver histology in adults with nonalcoholic steatohepatitis (NASH) but not diabetes, but its impact on long-term patient outcomes is unknown. We evaluated whether vitamin E treatment improves clinical outcomes of NASH patients with bridging fibrosis or cirrhosis. Two hundred and thirty-six patients with biopsy-proven NASH and bridging fibrosis or cirrhosis seen at Indiana University Medical Center between October 2004 and January 2016 were included. Ninety of them took 800 international units/day of vitamin E for ≥2 years (vitamin E users) and were propensity-matched to 90 adults who did not take vitamin E (controls) after adjusting for fibrosis severity, age, gender, body mass index, comorbidities and their treatment, low-density lipoprotein cholesterol, liver biochemistries, and length of follow-up on vitamin E. Covariate-adjusted Cox and competing risk regression models were assessed to evaluate the association between vitamin E treatment and patient outcomes. The median follow-up was 5.62 (interquartile range [IQR], 4.3-7.5) and 5.6 (IQR, 4-6.9) years for vitamin E users and controls, respectively. Vitamin E users had higher adjusted transplant-free survival (78% versus 49%, P < 0.01) and lower rates of hepatic decompensation (37% versus 62%, P = 0.04) than controls. After controlling for severity of fibrosis, calendar year of patient enrollment, and other potential confounders, vitamin E treatment decreased the risk of death or transplant (adjusted hazard ratio, 0.30; 95% confidence interval [CI], 0.12-0.74; P < 0.01) and hepatic decompensation (adjusted sub-HR, 0.52; 95% CI, 0.28-0.96; P = 0.036). These benefits were evident in both those with diabetes and those without diabetes. Adjusted 10-year cumulative probabilities of hepatocellular carcinoma, vascular events, and nonhepatic cancers were not different between vitamin E-exposed patients and controls. Conclusion: Vitamin E use was associated with improved clinical outcomes in patients with NASH and bridging fibrosis or cirrhosis.
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In 236 NASH patients with bridging fibrosis or cirrhosis, Vitamin E 800 IE/day decreased the risk of death or transplantation and hepatic decompensation, both in diabetic and non-diabetic patients.
“A study evaluating the effect of Vitamin E on clinical outcomes in 236 NASH patients with bridging fibrosis or cirrhosis found that indeed 800 IE/day decreased the risk of death or transplantation and hepatic decompensation —both in diabetic and in non‐diabetic patients [34]”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [34]
The Study Cohort and outcomes sections report 236 eligible patients and lower risks of death or transplant and hepatic decompensation among vitamin E users; the Accepted Article states that the association was observed in both diabetic and non-diabetic patients. However, the authors explicitly caution that this non-randomized study cannot establish that vitamin E caused the reductions, so “decreased the risk” overstates the finding if read causally. (LLM, conf=0.83)
Experimental — accuracy not yet measuredFor individuals with MASH and bridging fibrosis or cirrhosis, case-control studies have shown that long-term exposure to vitamin E is associated with decreased risk of death, transplant and hepatic decompensation.
“For individuals with MASH and bridging fi brosis or cirrhosis, casecontrol studies have shown that long-term exposure to vitamin E is associated with decreased risk of death, transplant and hepatic decompensation.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [371]
The Study Cohort section describes patients with NASH (now termed MASH) and bridging fibrosis or compensated cirrhosis who received vitamin E or did not. The outcomes section reports lower mortality or transplantation and hepatic decompensation among vitamin E users. The source describes one propensity-matched cohort study, however, not multiple case-control studies. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe study of Vitamin E on clinical outcomes in 236 NASH patients was not a randomized controlled trial.
“the latter study was no randomized controlled trial”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [34]
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- Authors
- Vilar‐Gomez, E., Vuppalanchi, R., Gawrieh, S., Ghabril, M., Saxena, R., Cummings, O. W., & Chalasani, N.
- Affiliations
- Division of Gastroenterology and Hepatology,Indiana University School of Medicine,Indianapolis,IN
- Indiana University School of Medicine (US)
- Corresponding author
- Chalasani, Naga
- ORCID
- Venue
- Hepatology
- Published
- 2019-03-06
- Volume
- 71
- Issue
- 2
- Pages
- 495-509
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W2902465653
- Cited by
- 193
- References
- 46
- Citations by year
- 2026: 10 · 2025: 31 · 2024: 30 · 2023: 22 · 2022: 25 · 2021: 37 · 2020: 25 · 2019: 13
- FWCI
- 14.63
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- vitamin E, nonalcoholic steatohepatitis, bridging fibrosis, liver cirrhosis, transplant-free survival, hepatic decompensation, hepatocellular carcinoma, diabetes mellitus, long-term clinical outcomes, competing risk analysis
- MeSH terms
- Female, Humans, Liver Cirrhosis, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Vitamin E, Vitamins, Liver Transplantation, Disease-Free Survival, Non-alcoholic Fatty Liver Disease
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