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Dear Dr. Roach: I'm a 65-year-old male. On my recent semiannual checkup, my labs showed an AST level of 53 U/L and an ALT level of 62 U/L. I am concerned about nonalcoholic fatty liver disease. In addition to losing weight, is 800 IU of vitamin E potentially beneficial? -- H.C.
Answer: Metabolic dysfunction-associated steatotic liver disease (MASLD, the newer and more correct name for fatty liver disease) is an increasingly common cause of abnormal liver function tests. But it can progress to steatohepatitis (MASH), which can cause fibrosis, inflammation, and ultimately cirrhosis of the liver. The disease by definition excludes people with heavy alcohol consumption.
In people at risk for MASLD (those who are very overweight or obese or have diabetes, high blood pressure, and abnormal cholesterol), physicians should consider the diagnosis, especially in people with a previous family history or elevated liver enzymes. (AST and ALT are liver enzymes that reflect damage to the liver cells, called hepatocytes.)
Before starting a treatment such as vitamin E, I recommend making a firm diagnosis, which can usually be done by excluding other dangerous causes such as viral hepatitis, iron and copper storage diseases, celiac disease, and less-common liver diseases like primary biliary cholangitis and alpha-1 anti-trypsin deficiency. This is then followed by an ultrasound.
If the disease is confirmed by an ultrasound, most experts will determine the stage of MASLD by a noninvasive procedure called VCTE. ("FibroScan" is one well-known brand.) People who have MASH but do not have diabetes are often recommended vitamin E.
Weight loss through a healthy diet and regular exercise is the mainstay of treatment for MASLD without MASH. There may be some benefit of vitamin E even in people without MASH, but not all studies have shown this.
In my opinion, it's more important for you to be sure that you don't have another cause for the elevated liver enzymes and make a diagnosis (and staging if necessary) than it is for you to start vitamin E now. Vitamin E does increase the risk of prostate cancer, so I do not recommend it in people who are at a high risk due to a personal or family history of prostate cancer.