Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2749
Peer-review started: July 6, 2015
First decision: September 8, 2015
Revised: September 20, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: November 28, 2015
AIM: To evaluate the efficacy of vitamin E treatment on liver stiffness in nonalcoholic fatty liver disease (NAFLD).
METHODS: Thirty-eight NAFLD patients were administered vitamin E for > 1 year. The doses of vitamin E were 150, 300, or 600 mg; three times per day after each meal. Responses were assessed by liver enzyme levels [aspartate aminotransferase (AST), alanine aminotranferease (ALT), and γ-glutamyl transpeptidase (γ-GTP)], noninvasive scoring systems of hepatic fibrosis-4 [FIB-4 index and aspartate aminotransferase-to-platelet index (APRI)], and liver stiffness [velocity of shear wave (Vs)] measured by acoustic radiation force impulse elastography. Vs measurements were performed at baseline and 12 mo after baseline. The patients were genotyped for the patatin-like phospholipase domain containing 3 (PNPLA3) polymorphisms and then divided into either the CC/CG or GG group to examine each group’s responses to vitamin E treatment.
RESULTS: We found marked differences in the platelet count, serum albumin levels, alkaline phosphatase levels, FIB-4 index, APRI, and Vs at baseline depending on the PNPLA3 polymorphism. AST, ALT, and γ-GTP levels (all P < 0.001); FIB-4 index (P = 0.035); APRI (P < 0.001); and Vs (P < 0.001) significantly decreased from baseline to 12 mo in the analysis of all patients. In the subset analyses of PNPLA3 genotypes, AST levels (P = 0.011), ALT levels (P < 0.001), γ-GTP levels (P = 0.005), APRI (P = 0.036), and Vs (P = 0.029) in genotype GG patients significantly improved, and AST and ALT levels (both P < 0.001), γ-GTP levels (P = 0.003), FIB-4 index (P = 0.017), and APRI (P < 0.001) in genotype CC/CG patients.
CONCLUSION: One year of vitamin E treatment improved noninvasive fibrosis scores and liver stiffness in NAFLD patients. The responses were similar between different PNPLA3 genotypes.
Core tip: Responses to vitamin E treatment in nonalcoholic fatty liver disease patients were assessed by noninvasive scoring systems of hepatic fibrosis, and liver stiffness (velocity of shear wave) was measured by acoustic radiation force impulse elastography. Vitamin E treatment for 1 year improved not only liver enzyme levels but also noninvasive fibrosis scores and liver stiffness. Subsequently, the patients were divided into two groups according to patatin-like phospholipase domain containing 3 (PNPLA3) genotype (CC/CG or GG) to examine whether either group responded differently to the treatment. The responses were similar between different PNPLA3 genotypes.