Aa
Aa
A
A
A
Close
Avatar universal

fatty liver

well i got my results today from my doc.i dont have hvc.not detected.im 20% of those people were ur body fights the dicease.well but i got a fattyliver.and send me meds to take and vitamin d.whats the worst that could happen?
4 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Study Confirms Benefits of Vitamin E in Nonalcoholic Steatohepatitis
Megan Brooks

May 4, 2010 — Supplementation with the natural form of vitamin E (800 IU/day) has beneficial effects in patients with nonalcoholic steatohepatitis (NASH), but pioglitazone's benefits are less clear, according to the latest findings from the Pioglitazone vs Vitamin E vs Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis (PIVENS) trial, reported online April 28 in the New England Journal of Medicine.

Earlier results from this phase 3 prospective, randomized double-blind placebo-controlled trial were presented as a late-breaking study in November 2009 at the American Association for the Study of Liver Diseases annual meeting.

NASH, for which there is no approved therapy, affects about 4% of the American population, and about 15% of patients with NASH progress to cirrhosis. It is associated with fatty liver disease, insulin resistance, and obesity.

In the PIVENS trial, Arun J. Sanyal, MD, from the Department of Gastroenterology, Hepatology, and Nutrition at Virginia Commonwealth University in Richmond, and a multicenter team studied 247 nondiabetic adults with biopsy-proven NASH with a nonalcoholic fatty liver disease activity score of 4 or higher within 6 months of randomization. The researchers allocated:

    * 80 patients to the insulin-sensitizer pioglitazone (30 mg once daily),
    * 84 patients to vitamin E (800 IU/day), and
    * 83 patients to placebo.

Liver biopsy was performed before treatment and, in 90% of study participants, after treatment.

The primary end point was an improvement in histology, defined as:

    * improvement by 1 or more points in the hepatocellular ballooning score,
    * no worsening of fibrosis, and
    * either a decrease in the nonalcoholic fatty liver disease activity score to 3 or less or a decrease of at least 2 points, with at least a 1-point decrease in either the lobular inflammation or steatosis score.

According to the investigators, vitamin E therapy compared with placebo was associated with a significantly higher rate of improvement in NASH (43% vs 19%; P = .001; number needed to treat, 4.2) after 96 weeks. However, the difference in the rate of NASH improvement with pioglitazone compared with placebo did not reach the prespecified 0.025 level of significance (34% vs. 19%; P = .04; number needed to treat, 6.9).

Sensitivity Analyses

Because of the subjectivity of histologic analysis, the study team performed several sensitivity analyses. They report that when no worsening (rather than improvement) of hepatocellular ballooning was the criterion, both active drugs were significantly associated with an improvement in NASH histology compared with placebo (placebo vs vitamin E: 25% vs 51% improvement; P < .001; placebo vs pioglitazone: 25% vs 48%; P = .003).

When paticipants who did not have hepatocellular ballooning initially were excluded from the analyses, both active drugs were associated with a significant improvement in histologic findings (placebo vs vitamin E: 23% vs 52% improvement; P < .001; placebo vs pioglitazone: 23% vs 47%; P = .002).

There were no baseline factors significantly predictive of histologic response to either vitamin E or pioglitazone.

Secondary Outcomes

Compared with placebo, both vitamin E and pioglitazone led to reductions in serum alanine and aspartate aminotransferase levels (P < .001 for both comparisons), as well as hepatic steatosis (P = .005 for vitamin E and P < .001 for pioglitazone) and lobular inflammation (P = .02 for vitamin E and P = .004 for pioglitazone).

There was no improvement in fibrosis scores (P = .24 for vitamin E and P = .12 for pioglitazone).

As expected, only pioglitazone was associated with significant improvement in insulin resistance (P = .03 vs placebo), but that group was also the only group that saw a significant mean weight gain (+4.7 kg at week 96; P < .001 vs placebo). With the exception of weight gain, the overall distribution of adverse events did not differ significantly across groups, the researchers report. No significant changes in quality of life were noted with either treatment compared with placebo, and there were no drug-related serious adverse events.

Outside Perspective

These findings are somewhat "surprising for vitamin E," Stephen A. Harrison, MD, chief of hepatology, Brooke Army Medical Center, Ft. Sam Houston, Texas, who was not involved in the study, noted in a telephone interview with Medscape Gastroenterology.

"We did a study earlier on vitamin E that didn't really show a benefit, and to have this study, as rigorous as they did it, show a benefit is surprising, and quiet honestly hard to explain why.

"Certainly, it is thought that oxidative stress plays a role in fatty liver disease and its progression, particularly in NASH, so that's been the impetus behind using vitamin E. This study shows it may actually confer a benefit in close to half the patients that take it," Dr. Harrison said.

He also noted that the pioglitazone group actually had a clinically significant higher rate of NASH resolution than the vitamin E group (47% vs 36%), "so even though they didn't reach the statistical endpoint that they wanted to with pioglitazone, it still resolved half the NASH. I find that very provocative," Dr. Harrison said. The fact that the study used a "middle-of-the-road dose of pioglitazone may be why they didn't see a bigger benefit," he added.

Treat the Cause

"The first rule of thumb in treating fatty liver disease is 'shoot for what causes it,' and we know this is linked to obesity, prediabetes, and frank diabetes," Dr. Harrison told Medscape Gastroenterology. "Therefore, we always aim for diet and exercise up front — ideally, a 10% reduction in weight, which has been correlated with an improvement in insulin resistance and histology. In my clinical practice, I also recommend that people take vitamin E 800 IU/day.

"In patients who have more advanced disease, where I am worried about them progressing and they are not able to lose the weight, those are the people I would put on a trial of pioglitazone," he added.

Need to Know

This study, Dr. Harrison said, also raises a key question: "What is it about the roughly 50% of people with NASH who do not respond to pioglitazone? This is an important question going forward in my mind: figuring out what are the characteristics that are unique to the patients who don't derive any benefit from pioglitazone," Dr. Harrison said.

This study was supported by grants from the National Institutes of Health and National Cancer Institute. Additional support was provided by Takeda Pharmaceuticals, North America. Dr. Sanyal reports relationships with several companies including Exalenz, Takeda, Norgine, Astellas, Amylin, Intercept, Gilead, Roche, Salix, Sanofi-Aventis, Otsuka, and Orphan Therapeutics. Several study coauthors also report drug company relationships. Dr. Harrison has disclosed no relevant financial relationships.

N Engl J Med. Published online April 28, 2010.

http://www.medscape.com/viewarticle/721221
Helpful - 0
29837 tn?1414534648
Read more here...

http://www.mind1st.co.uk/Omega-3-Fish-Oil-Liver-Disease-Research.asp

Magnum
Helpful - 0
29837 tn?1414534648
The $17 price is at Costco...

Magnum
Helpful - 0
29837 tn?1414534648
Also look into fish oil. Don't skimp on price and quality though. I take Wild Alaskan Salmon oil with Omega-3. You can get it a Costo and other places. About $17 for 180 softgels at 1000mg each. Reports say it cuts down on fatty liver, which is a typical occurance with Hep C victims... Way overpriced here at amazon.com, but this is the product.
http://www.amazon.com/Pure-Alaska-Alaskan-Salmon-Softgels/dp/B002TUMWSM

Magnum
Helpful - 0
Have an Answer?

You are reading content posted in the Hepatitis C Community

Top Hepatitis Answerers
317787 tn?1473358451
DC
683231 tn?1467323017
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.