Vitamin E in Nonalcoholic Fatty Liver Disease

  • Bubu A. Banini
  • Arun J. SanyalEmail author
Part of the Nutrition and Health book series (NH)


Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide, accounting for over 100 billion dollars in annual direct medical costs in the United States alone. Nonalcoholic steatohepatitis (NASH) is a subtype of NAFLD that can progress to cirrhosis and liver cancer. To date, there are no approved pharmacological therapies for NASH. Vitamin E is an antioxidant that has been shown to improve the histological features of NASH in both preclinical and clinical studies. Several clinical practice guidelines recommend vitamin E as off-label treatment for NASH. Here, we discuss the complex pathogenesis of NASH, with emphasis on oxidative stress and organelle dysfunction. We summarize evidence supporting the beneficial role of vitamin E supplementation on NASH and on liver fibrosis, based on studies in animal models of NAFLD, in clinical trials of NAFLD patients and in meta-analyses. We briefly highlight the use of vitamin E in other forms of chronic liver disease, including alcoholic liver disease and chronic viral hepatitis, where the role of vitamin E supplementation remains controversial. Finally, we discuss safety concerns related to the long-term use of vitamin E and suggest that risks and benefits be discussed with patients prior to initiating vitamin E supplementation.


α-tocopherol Metabolic syndrome Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Oxidative stress PIVENS trial TONIC trial Vitamin E 







Alanine aminotransferase


Clinical Research Network


Cytochrome P450 2E1


Endoplasmic reticulum


Flavin adenine dinucleotide


Free fatty acids


Glutathione peroxidase




Insulin resistance


Janus kinase






Mitochondrial respiratory complex


Nicotinamide adenine dinucleotide


Nonalcoholic fatty liver


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis


Peroxisome proliferator-activated receptor-α


Polyunsaturated fatty acids


Randomized control trial


Reactive oxygen species


Selenium and Vitamin E Cancer Prevention Trial


SH3 domain-binding protein 5


Tumor necrosis factor


Treatment of nonalcoholic fatty liver disease in Children


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology and Nutrition, Department of Internal MedicineVirginia Commonwealth UniversityRichmondUSA

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