The Role of Vitamins in Non-Alcoholic Fatty Liver Disease: A Systematic Review

Abstract

Non-Alcoholic Fatty Liver Disease (NAFLD) emerged as the most prevalent liver disorder contributing significantly to disease burden worldwide. It manifests as a broad spectrum of hepatic damage with varying severity ranging from less serious steatosis to a more severe Non-Alcoholic Steatohepatitis (NASH), with or without fibrosis, cirrhosis, and hepatocellular carcinoma. Vitamins, on the other hand, are micronutrients that are vital for healthy well-being. Some studies have linked liver diseases with hypovitaminosis; however, there are still some gaps about the basis of their correlation. Hence, this systematic review aims to discuss the role of vitamins in the pathogenesis of NAFLD and explore their hepatoprotective potential that may benefit clinicians in managing this condition. This systematic review searched for studies indexed in the PubMed, PubMed Central, Medline, Google Scholar, and ScienceDirect databases. Inclusion and exclusion criteria were applied, duplicates were removed, and meticulous screening of articles was done systematically. Out of 729 unique studies generated using the search strategy, 17 were finally included after thorough review and quality appraisal. NAFLD is not simply an outcome of insulin resistance and metabolic derangements; instead, it is a disease with complex underlying pathogenesis. Moreover, vitamin deficiency has been associated with NAFLD development and increased susceptibility to more severe liver damage. Derangement in vitamins correlates to the lipotoxic hepatic environment, altered immune system, unwarranted inflammation, oxidative stress, gene mutations, epigenetic modification, and gut dysbiosis seen in NAFLD. As they influence several pathophysiologic processes in the liver, vitamins A, B3, B6, B9, B12, C, D, and E are promising potential options that can impact NAFLD management. However, more well-designed studies conducted in the human population are still necessary to establish their efficacy and safety as therapeutic agents.

Folate Deficiency Increased Lipid Accumulation and Leptin Production of Adipocytes

“…In addition to enhancing fatty acid synthesis, folate deficiency also decreases the methylation and thus the formation of phosphatidylcholine, leading to less very low-density lipoprotein produced for hepatic lipid efflux ( 25 ). Therefore, an increasing number of evidence suggested the association between folate status with non-alcoholic fatty liver disease in the recent review articles ( 35 , 36 ). In our study, folate-deficient mice also had more steatosis, hepatocytes ballooning, and lobular inflammation, suggesting that chronic lipid accumulation enhanced by folate deficiency might result in pathological changes in the liver.…”

Nonalcoholic Fatty Liver Disease and Altered Neuropsychological Functions in Patients with Subcortical Vascular Dementia

“…NAFLD is strictly associated with obesity and higher glycated levels [ 61 , 62 ], with lower levels of folate and vitamin B12 [ 63 , 64 ], and a reduction in folate level [ 65 ]. More recently, NAFLD has been associated with higher levels of homocysteine [ 66 ] and most probably hypovitaminosis D [ 13 , 66 ].…”

Nutrition as Therapy in Liver Disease

“…Vitamin A, vitamin B 3 , folic acid, vitamin C, and vitamin D have all been studied in the context of NAFLD, but these studies fail to provide any conclusive evidence on the routine administration of such micronutrients for the management of NAFLD. 35 However, among the micronutrients, vitamin E is the most validated to treat patients with NAFLD. The PIVENS (Pioglitazone, Vitamin E or Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis) trial showed that 800 IU of vitamin E daily was associated with improvement in transaminases and histologic steatosis and inflammation.…”