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Abstract
Background Chronic liver diseases (CLD) represent a major public health problem, accounting for significant mortality of more than 1.75 million deaths are attributed to it. Among these, Non-alcoholic fatty liver disease (NAFLD) is a rapidly increasing cause, with an estimated 13.5% to 31.8% affected globally. Asia has a 33% prevalence rate based on a population study. NAFLD includes a wide spectrum of conditions, from a simple fatty liver, nonalcoholic steatohepatitis (NASH) and cirrhosis or liver cancer. Recent studies have shown that the risk of developing NASH is 4–11 times higher in patients with metabolic syndrome as compared with healthy individuals. The mainstay of treatment for NAFLD is the adoption of healthy lifestyle modification. However, among all the therapeutic options based on recent guidelines, Vitamin E appears to be the frontline treatment for non-alcoholic steatohepatitis (NASH) in non-diabetic adults, with potent anti-inflammatory and antioxidant properties which may reduce liver injury in NAFLD. Tocotrienols have been revered as the new Vitamin E, which is 100 times more absorbed than Tocopherol and with more efficient penetration into the fat tissues. The study focuses on the hepatoprotective effects of Tocotrienol in patients with NASH.
Methods The RCTs reviewed involved 128 non-diabetic patients with 61 patients receiving Tocotrienol (experimental group) at 200 mg/tab, twice daily and 67 patients given placebo (control group). The subject population is demographically homogenous. Other causes of CLD were excluded. Outcome measure includes the reduction in liver transaminases. Statistical tools include the use of Review Manager (RevMan). Sensitivity analysis was analyzed using Mantel-Haenszel procedure for binary data to determine the clinical significance of the effect. Sensitivity analysis was two-tailed, set at p-value < 0.05. Heterogeneity was calculated with i2 statistics. Odds ratio was assessed at 95% confidence interval (CI).
Results Results in this meta-analysis
Non-diabetic patients receiving tocotrienols had significant reduction of liver transaminases specifically ALT with a p-value of <0.002.
The table is attached (figure 1).
Conclusions This study showed that tocotrienols may have significant hepatoprotective effects in NASH patients in terms of reduction of ALT levels.