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Effect of vitamin E in non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomised controlled trials
  1. Iram Amanullah1,
  2. Yusra Habib Khan1,
  3. Iqraa Anwar1,
  4. Aqsa Gulzar1,
  5. Tauqeer Hussain Mallhi2,
  6. Ahsan Aftab Raja3
  1. 1 Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
  2. 2 Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
  3. 3 School of Pharmacy, Taylor's University, Subang Jaya, Selangor, Malaysia
  1. Correspondence to Dr Yusra Habib Khan, Institute of Pharmacy, Lahore College for Women University, Jail Road, 54000 Lahore, Punjab, Pakistan; yusrahabib{at}; Dr Tauqeer Hussain Mallhi, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Allama Iqbal Road, 38000 Faisalabad, Pakistan; tauqeer.hussain.mallhi{at}


The efficacy of vitamin E among patients with non-alcoholic fatty liver disease (NAFLD) is unclear. The current qualitative and quantitative analyses aimed to ascertain the efficacy of vitamin E on clinical outcomes of patients with NAFLD. A systematic search of randomised controlled trials (RCTs) was performed using databases (PubMed, ProQuest, Scopus, EBSCOhost and Ovid) from inception to July 2018. Trials meeting the inclusion criteria were subjected to quality assessment using the Jadad Scoring. All trials meeting the prerequisites information for meta-analysis were subjected to quantitative synthesis of results. Nine RCTs (five in adults and four in children) were included. Four of the five RCTs on adults demonstrated significant improvements in alanine transaminase and other liver function surrogates in patients with NAFLD. On the other hand, only one of the four RCTs conducted on children showed significant improvements in liver functions with the use of vitamin E. Although quantitative synthesis of available data revealed insignificant differences between vitamin E and placebo, still the use of vitamin E improves the level of alanine transaminase and aspartate transaminase by −1.96 and −0.59, with heterogeneity of I2=67% and I2=0%, respectively. Adjuvant vitamin E therapy provides significant biochemical and histological improvements in adult patients with NAFLD, while paediatric patients showed insignificant efficacy compared with placebo. Lifestyle interventions along with vitamin E can provide much better results. Data, including the impact of vitamin E on hepatic histology, are still lacking. Moreover, the short duration of trials limits the conclusion on the safety and efficacy of proposed treatments.

  • nonalcoholic fatty liver disease
  • non-alcoholic steotohepatitis
  • randomized controlled trials
  • vitamin e
  • liver disease
  • liver
  • fibrosis
  • fatty liver
  • non-alcoholic, injury
  • NASH
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  • Correction notice This paper has been corrected since it appeared Online First. Footnote ‡ has been removed from table 5.

  • Contributors YHK conceptualised the plan for the current study. IAm, IAn and AG did the literature search, screening and data extraction, and drafted the manuscript. AAR performed the meta-analysis for the included studies. YHK assisted in interpreting the results. YHK and THM assessed the data quality and approved the final version of the manuscript for submission. All authors have critically reviewed the manuscript. YHK is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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