Saudi Journal of Gastroenterology
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SYSTEMATIC REVIEW AND META-ANALYSIS
Year : 2014  |  Volume : 20  |  Issue : 3  |  Page : 143-153

Does vitamin E improve the outcomes of pediatric nonalcoholic fatty liver disease? A systematic review and meta-analysis


1 Department of Pediatric, Gastroenterology Unit, King Khalid University Hospital; Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia
2 Children's Hospital, King Fahad Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 Liver Research Unit, Bambino Gesù Children's Hospital and Research Institute, Roma, Italy

Correspondence Address:
Dr. Ahmed A. Sarkhy
P. O. Box 241765, Riyadh 11322
Saudi Arabia
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Source of Support: This work was supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University,, Conflict of Interest: None


DOI: 10.4103/1319-3767.132983

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Background and Aims: To systemically evaluate the efficacy of adjuvant vitamin E on the outcomes of nonalcoholic fatty liver disease (NAFLD) and/or nonalcoholic steatohepatitis (NASH) in children. Materials and Methods: We searched MEDLINE, PUBMED, EMBASE, the Cochrane Central Register Controlled Trials, and the Cochrane Database of Systematic Reviews over the period between January 1980 and September 2012 for the studies that examined the role of adjuvant vitamin E given at any dose or duration, alone or in combination with other interventions, on the outcome of pediatric NAFLD. The outcomes are alanine aminotransferase (ALT) normalization and histological improvement. Results: Five randomized trials were eligible to be included in our analysis, with a total of 270 participants. There was no statistically significant difference in the effect of adjuvant vitamin E on normalizing serum ALT [risk ratio (RR) =1.18, confidence interval (CI) =0.92-1.53, P = 0.77 for heterogeneity, I2 = 0%]. Sensitivity analysis showed that using higher doses of vitamin E, a longer duration of therapy or adding vitamin C did not change the effect on the measured outcome. Only two studies looked at histological changes as an outcome. We observed substantial heterogeneity between the two studies. Conclusions: Our meta-analysis did not find a significant effect of adjuvant vitamin E over placebo in normalizing serum ALT. Data on the long-term effect of adjuvant vitamin E on histological improvements in NAFLD patients are still lacking. Larger, well-designed randomized controlled trials (RCTs) in children with histological endpoints are still needed to answer this question.


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