C0513 - Outcomes of Vitamin E Therapy in a Veteran Population With Non-Alcoholic Steatohepatitis Among Groups With and Without Diabetes

Amal Shine, MD¹, Matthew Heckroth, MD¹, Mohamed Elmasry, MD¹, Nanlong Liu, MD¹, Sudaraka Tholkage, MS², Maiying Kong, PhD³, Ashutosh Barve, MD, PhD³, Matthew Cave, MD³, Craig McClain, MD, FACG^3
1University of Louisville School of Medicine, Louisville, KY; ²University of Louisvile School of Medicine, Louisvile, KY; ³University of Louisville, Louisville, KY

Introduction: Vitamin E (VitE) is an antioxidant used as a therapy for non-alcoholic steatohepatitis (NASH). Studies indicate a link between the severity of NASH and degree of oxidative stress. VitE can also retard hepatic fibrosis by modulating cell injury and proliferation. VitE has been shown to decrease inflammation, transaminitis and steatosis in NASH patients without Type 2 diabetes (T2DM). Current guidelines do not support its use in patients with T2DM. We conducted a study in a Veteran population to assess trends in transaminases and fibrosis 4 (FIB-4) scores after VitE use in patients with NASH, both with and without T2DM.

Methods: Veterans Affairs (VA) Informatics and Computing Infrastructure was used to build patient cohorts from VA hospitals nationwide. ICD-10 codes identified patients with NASH and T2DM. Retrospective analysis of labs and FIB-4 scores was performed. Before/after analysis was done to study the effect of VitE on outcomes. Wilcoxon signed-rank test with continuity correction analyzed FIB-4 scores, and a linear mixed-effect model assessed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) trends.

Results: Of 1572 patients with NASH on VitE, 658 had complete data. Mean age was 55.8 years; 588 (89.4%) patients were male and 528 (80.2%) Caucasian. 283 (43.0%) patients had T2DM, and 518 (78.7%) were obese (BMI≥30). Both diabetic and non-diabetic groups had significant decline in mean AST and ALT over 2 years (p< 0.05), with no significant difference between the groups in their rate of change. (Figure 1) Interestingly, the non-diabetic group had higher baseline AST and ALT. Both groups had significantly lower FIB-4 scores 1 year after VitE, p=0.001 and 0.0005, respectively. (Table 1) Mean BMI and hemoglobin A1c were lower after two years.

Discussion: VitE therapy reduced ALT and AST levels in both diabetic and non-diabetic groups. ALT is a reliable marker of liver injury, and FIB-4 score is a validated predictor of liver fibrosis. Lower FIB-4 scores in both groups suggest that VitE may also improve fibrosis, likely via reducing long-term inflammation, though effects were modest. Study limitations include a retrospective model and confounding effects of other medications or weight-reduction strategies that may have lowered BMI and hemoglobin A1c. Even so, VitE may have a role in improving inflammation and fibrosis in NASH in both diabetic and non-diabetic groups. Further prospective studies are needed to clarify the role of VitE in treating NASH patients with T2DM.




Disclosures:


Amal Shine, MD¹, Matthew Heckroth, MD¹, Mohamed Elmasry, MD¹, Nanlong Liu, MD¹, Sudaraka Tholkage, MS², Maiying Kong, PhD³, Ashutosh Barve, MD, PhD³, Matthew Cave, MD³, Craig McClain, MD, FACG³. C0513 - Outcomes of Vitamin E Therapy in a Veteran Population With Non-Alcoholic Steatohepatitis Among Groups With and Without Diabetes, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.