Vit E In MASLD

A 49-year-old woman presented with a gradual onset of symptoms, including loss of appetite, nausea, upper abdominal discomfort, and fatigue over the past 2 months. She also had a 1-year history of hypertension treated with telmisartan 40 mg once daily, but no history of diabetes or lipid problems. Her family had a history of liver cirrhosis, but she didn't know the cause of her elder brother's liver disease.

On examination, there were no visible signs of liver issues, and her vital signs were all within the normal range. She weighed 68 kg, had a BMI of 28.2 kg/m², and had no generalized lymphadenopathy. Tests revealed some liver abnormalities, including elevated liver enzymes, total bilirubin 1.3 mg/dl (direct 0.3 mg/dl, indirect 1 mg/dl), serum albumin 4.5 g/dl, and globulin 3.4 g/dl. Serum alkaline phosphatase and GGT were normal. Ultrasonography of the upper abdomen showed a bright echogenic liver consistent with fatty liver disease (grade I–II). A hepatic FibroScan revealed a median value of 5.6 kPa, which indicates no fibrosis. A provisional diagnosis of NAFLD was made, and the patient was advised to follow a strict fat-restricted diet, exercise, and take vitamin E 400 mg once daily.

Autoimmune markers were tested due to her family history, with a positive ANA-HEp-2 result. Other markers were negative. The patient did not give consent for a liver biopsy. She was advised to attend a follow-up consultation 3 months later. After 3 months, the patient was symptomatically better. She still had 1 cm hepatomegaly and had lost 5 kg in weight. Repeat LFT showed improvement in ALT, while other LFT results were normal.1