PMID- 37719477
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230919
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 8
DP  - 2023 Aug
TI  - Vitamin E and Pioglitazone: A Comprehensive Systematic Review of Their Efficacy 
      in Non-alcoholic Fatty Liver Disease.
PG  - e43635
LID - 10.7759/cureus.43635 [doi]
LID - e43635
AB  - Non-alcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent 
      worldwide, especially in people with obesity, dyslipidemia, type 2 diabetes 
      mellitus (T2DM), and metabolic syndrome. Weight loss and dietary modifications 
      are established first-line treatments for NAFLD. Currently, there is no approved 
      drug for NAFLD; however, pioglitazone and vitamin E have shown some beneficial 
      effects. This systematic review covers the comparative efficacies of vitamin E, 
      pioglitazone, and vitamin E plus pioglitazone. As of December 2022, the sources 
      for prior literature review included PubMed, PubMed Central, and Medline. We 
      included studies assessing the efficacy of pioglitazone, vitamin E, and vitamin E 
      plus pioglitazone in improving liver histology, liver markers, and lipid profile 
      when compared to other interventions in patients with NAFLD/non-alcoholic 
      steatohepatitis (NASH). Review materials include randomized control trials 
      (RCTs), traditional reviews, systematic reviews, meta-analyses, and observational 
      studies on human participants published within the last five years in the English 
      language. Studies on animals, pediatric populations, and with insufficient data 
      were excluded from the review. Two authors scanned and filtered articles 
      independently and later performed quality checks. A third reviewer resolved any 
      conflicts. The risk of bias was assessed using the Preferred Reporting Items for 
      Systematic Reviews and Meta-Analyses 2020 guidelines for systematic reviews, the 
      Cochrane Risk of Bias Tool for RCTs, and the Scale for the Assessment of 
      Narrative Review Articles for Traditional Reviews. A total of 21 articles were 
      shortlisted. The results showed that pioglitazone and vitamin E are effective in 
      reducing steatosis, inflammation, and ballooning, reducing liver markers, but 
      there seem to be conflicting data on fibrosis resolution. Pioglitazone decreases 
      triglycerides and increases high-density lipoproteins. One study has suggested 
      that pioglitazone has superior efficacy to vitamin E in fibrosis reduction and 
      vitamin E plus pioglitazone has superior efficacy than pioglitazone alone for 
      NASH resolution. However, these conclusions require further validation through 
      extensive analysis and additional research. In conclusion, diabetic patients with 
      NAFLD can be given pioglitazone, and non-diabetic patients with NAFLD can be 
      given vitamin E.
CI  - Copyright (c) 2023, Mazhar et al.
FAU - Mazhar, Iqra J
AU  - Mazhar IJ
AD  - Research, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
AD  - Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK.
FAU - Yasir, Mohamed
AU  - Yasir M
AD  - Internal Medicine, Kursk State Medical University, Kursk, RUS.
AD  - Research, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Sarfraz, Saba
AU  - Sarfraz S
AD  - Research, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Shlaghya, Gandhala
AU  - Shlaghya G
AD  - Research, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Narayana, Sri Harsha
AU  - Narayana SH
AD  - Research, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Mushtaq, Ujala
AU  - Mushtaq U
AD  - Research, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Shaman Ameen, Basim
AU  - Shaman Ameen B
AD  - Orthopedics, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Nie, Chuhao
AU  - Nie C
AD  - Research, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Nechi, Daniel
AU  - Nechi D
AD  - Family Medicine, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
FAU - Penumetcha, Sai Sri
AU  - Penumetcha SS
AD  - General Medicine, California Institute of Behavioral Neurosciences & Psychology, 
      Fairfield, USA.
AD  - General Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, 
      IND.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20230817
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10504864
OTO - NOTNLM
OT  - nafld
OT  - non-alcoholic fatty liver disease
OT  - pioglitazone
OT  - systematic review
OT  - thiazolidinedione
OT  - vitamin e
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/09/18 06:42
MHDA- 2023/09/18 06:43
PMCR- 2023/08/17
CRDT- 2023/09/18 04:22
PHST- 2023/07/10 00:00 [received]
PHST- 2023/08/17 00:00 [accepted]
PHST- 2023/09/18 06:43 [medline]
PHST- 2023/09/18 06:42 [pubmed]
PHST- 2023/09/18 04:22 [entrez]
PHST- 2023/08/17 00:00 [pmc-release]
AID - 10.7759/cureus.43635 [doi]
PST - epublish
SO  - Cureus. 2023 Aug 17;15(8):e43635. doi: 10.7759/cureus.43635. eCollection 2023 
      Aug.