Effect of vitamin E on cardiometabolic factors in paediatric metabolic dysfunction-associated steatotic liver...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a serious disease and increasingly prevalent in children. MASLD is associated with health consequences such as type 2 diabetes and CVD. While vitamin E is a potent antioxidant that has been proposed to improve liver function and cardiometabolic health including liver markers, lipid profile, glycaemic control and anthropometric measurements. A comprehensive search was conducted up to March 2025. Data on anthropometric measures, liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transferase (GGT)), glycaemic indices (fasting blood sugar (FBS), insulin, homeostatic model assessment for insulin resistance (HOMA-IR)), lipid profiles (total cholesterol (TC), TAG, LDL-cholesterol, HDL-cholesterol) and serum vitamin E levels were extracted. Statistical analyses were performed using a random-effects model. Eleven randomised controlled trials involving 665 participants were included in this study. Vitamin E significantly reduced ALT (weighted mean difference (WMD) = -5·23 U/L; 95 % CI: -7·72, -2·75; P < 0·001) and AST (WMD = -3·00 U/L; 95 % CI: -4·59, -1·41; P < 0·001), reflecting improved liver function. It also decreased TC (WMD = -5·77 mg/dl; 95 % CI: -11·46, -0·09; P = 0·04) and HOMA-IR (WMD = -0·82; 95 % CI: -1·28, -0·37; P < 0·001), while significantly increasing serum vitamin E levels (WMD = 9·16 mg/l; 95 % CI: 3·29, 15·03; P = 0·002). No significant changes were observed in the BMI, GGT, FBS, insulin, LDL-cholesterol, HDL-cholesterol or TAG levels. Vitamin E supplementation in paediatric MASLD appears to favourably influence key liver enzymes such as ALT, AST and certain metabolic factors including TC, and HOMA-IR levels, supporting its potential role as adjunctive therapy.