Vitamin E and C Intake is Inversely Associated with Liver Damage in Patients with Non-Alcoholic Fatty Liver Disease

Background & Aims: The pathogenesis of non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) involves oxidative stress and thus, antioxidants can have protective value. However, there is limited evidence on the benefit of dietary intake of antioxidants, mainly vitamins E and C. The aim of this study was to test the association between dietary vitamins E and C intake and NAFLD, NASH and fibrosis markers.

Methods: Cross-sectional analysis of NAFLD-lifestyle screening study. NAFLD was evaluated by ultrasonography and presumed steatosis, NASH and fibrosis by FibroMax. The level of steatosis was defined using SteatoTest as continues variable, significant NASH defined as ≥2 and borderline-significant fibrosis as ≥F1-F2. Nutritional intake was measured by food frequency questionnaire (FFQ).

Results: A total of 789 subjects were included (52.6% men, age 58.83±6.58 years). Reliable FibroMax test was obtained from 714 subjects. Adjusting for age, gender, BMI, dietary and lifestyle factors, the upper tertile of vitamin E intake per 1000 Kcal was associated with lower odds of NASH (OR= 0.64, 0.43-0.94, P= 0.024). There was an inverse association between reaching the recommended vitamin E intake and NASH (OR= 0.48, 0.30-0.77, P= 0.002). The upper tertile of vitamin C intake per 1000 Kcal was associated with lower odds of NAFLD and NASH (OR = 0.68, 0.47-0.99, P= 0.045; OR= 0.57, 0.38-0.84, P= 0.004; respectively). Both vitamins were related to the level of steatosis according to the SteatoTest, but not with fibrosis.

Conclusion: Higher vitamin E and C intake may be protective from NAFLD related liver damage.