Does vitamin E improve liver stiffness in metabolic dysfunction-associated steatotic liver disease?

Aims: It is not clear if vitamin E affects liver fibrosis in MASLD patients. In this study, we evaluated the effect of vitamin E on the liver stiffness measured by VCTE in patients with MASLD. Methods: In this retrospective cohort study, we identified MASLD patients who underwent serial measurements of liver stiffness by VCTE. Patients with viral hepatitis were excluded. Administration of other hepatotonics, i.e., ursodeoxycholic acid, silymarin, biphenyl dimethyl dicarboxylate, were controlled as covariates by multivariate logistic regression analysis.Results: A total of 5,055 patients with MASLD received at least 2 measurements of liver stiffness by VCTE during the period between July 2020 and March 2025. After excluding 1,206 patients with chronic hepatitis B and 105 patients with chronic hepatitis C, 3,746 patients were finally selected for analysis. The median duration of follow-up was 724 days (interquartile range = 549). The median change in liver stiffness measurement (LSM) was 0.2 kPa, 3.6% from baseline (interquartile range = 2.2kPa, 40%). The median duration of vitamin E therapy was 455 days (interquartile range = 720). Multivariate logistic regression analysis showed that use of vitamin E for more than 3 months was associated with significant improvement in LSM: the odds ratio for improvement of LSM more than 50% from baseline was 2.40 (95% confidence interval, 1.68 to 3.43).Conclusion: Use of vitamin E was associated with significant improvement of LSM in MASLD patients.