Dietary lecithin, antioxidant and vitamin B complex (LAB) decrease hepatic steatosis on patients with nonalcoholic steatoheaptitis (NASH)

Abstract

BACKGROUND: Recently, NASH has been recognized as a potentially progressive liver disease leading to the development of cirrhosis. Presently, there is no effective therapy for this disorder. AIM. To investigate the effects of dietary supplementation with lecithin, antioxidant and vitamin B complex (LAB) in patients who have NASH. METHODS: 4 patients, 1 male and 3 female, who had liver biopsy demonstrated NASH within 3 months prior to entering the study and increased aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) at least 1V2 time the upper limits of normal were recruited. These patients did not have other chronic liver disease, and were not on total parenteral nutrition or lipid lowering agents. Each patient was given 20 g dietary lecithin supplement with 2 tablets of antioxidants (250 mg vitamin C, 50 IU vitamin E, 2,500 IU beta carotene, 50 ug selenium) and vitamin B complex 300% RDA level twice a day for a total of 12 weeks. Baseline blood tests including serum AST, ALT, alkaline phosphatase, total bilirubin, lipid profile including total cholesterol, triglyceride, low density lipoprotein (LDL) and high density lipoprotein (HDL) were performed. The blood tests were repeated at 4, 8 and 12 weeks. Each patient had 2 computed tomography (CT) scans, one at the beginning of the study, and the other one at 12 weeks. A repeat liver biopsy was performed after treatment to confirm the change of fatty infiltration in CT scan. Attenuation values for regions of interest in the liver and spleen were generated from multiple representative sections and an average CT number in Hounsfield Units (HU) was then calculated. Liver density was determined by using liver-spleen differential obtained by substracting the average spleen CT number from the liver number to correct for interscan variability. 0-8 HU represents borderline fatty changes and < 0 corresponds to marked fatty infiltration. RESULTS: The full 12-week study was completed by all patients. No patients developed adverse or intolerable reactions during the study. The only significant changes in biochemical parameters were found in the reductions of both alkaline phosphatase and total bilirubin between baseline and week 4 (P < 0.05). There was a statistically significant difference between the 2 CT scans, at beginning (-6.03 +_ 9.67 HU) and at week 12 (5.72 -+ 5.40 HU) (P < 0.05). In terms of histological change when compared before and after treatment, there was no change in portal inflammation. Steatosis was reduced in 2 of the 4 patients but no change in the other 2 patients. 2 of the 4 patients showed increased lobular activity, and 3 of the 4 showed increased fibrosis. CONCLUSIONS: There was a statistically significant decrease in hepatic fat by increased liver-spleen CT HU after treatment with LAB. Hepatic steatosis may be reduced by LAB supplementation and may favorably impact on NASH. However, any clinical significance of the histological change is not clear at present. A randomized control trial is warranted.