Vitamin E and nonalcoholic fatty liver diseasePacana, Tommy; Sanyal, Arun J.Current Opinion in Clinical Nutrition & Metabolic Care: November 2012 - Volume 15 - Issue 6 - p 641–648 doi: 10.1097/MCO.0b013e328357f747 MICRONUTRIENTS: Edited by Gil Hardy and Henry Lukaski Abstract Author Information Purpose of review: Oxidative stress plays a central role in the transition from simple steatosis to nonalcoholic steatohepatitis (NASH). An effective therapeutic strategy is to target reduction in oxidative stress in NASH patients. The aim of this review is to discuss the role of oxidative stress in NASH and biological activities of vitamin E and present available evidence on the therapeutic efficacy of vitamin E in NASH. Recent findings: In Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis (PIVENS) trial, vitamin E therapy demonstrated a significant improvement in steatosis, inflammation, ballooning, and resolution of steatohepatitis in adult patients with aggressive NASH, who do not have diabetes or cirrhosis. Although vitamin E showed a significant resolution of NASH in children, a sustained reduction of alanine aminotransferase was not attained in The Treatment of nonalcoholic fatty liver disease (NAFLD) in Children (TONIC) trial. Summary: The prevalence of NAFLD is likely to increase over time due to the epidemics of obesity and diabetes. Presently, there is no definitive treatment for NAFLD. Based on available evidence, vitamin E (RRR-α-tocopherol) is only recommended in NASH adults without diabetes or cirrhosis and with aggressive histology. Validation is needed in children before its use can be recommended. Longer follow-up of randomized controlled trials are needed to assess long-term vitamin E safety. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA Correspondence to Dr Tommy Pacana, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, MCV Box 980341, Richmond, VA 23298-0341, USA. Tel: +1 804 828 6314; fax: +1 804 828 2037; e-mail: firstname.lastname@example.org © 2012 Lippincott Williams & Wilkins, Inc.