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Providing perspectives on recent research into vitamins and nutritionals


Is Your Life Being Shortened by a Lack of Vitamin E?

By Michael McBurney

Dr Arya Sharma, Professor of Medicine and Chair in Obesity Research and Management at the University of Alberta states that body mass index (BMI) is a poor indicator of health. Nevertheless, he is concerned by the rapid increase in the prevalence of severe obesity (BMI of 40-59.9 vs normal weight BMI 18.5-24.9) because of its association with a loss of 6.5 to 13.7 years of life.

Being overweight and obesity increases the risk of non-alcoholic fatty liver disease (NAFLD). 75% of those who are obese or have diabetes have NAFLD. Possibly 90% of those who are severely obese. There is no widely accepted pharmaceutical treatment for NAFLD. The metabolic etiology of NAFLD is unknown but oxidative stress is widely accepted as a contributing factor.

Vitamin E is an antioxidant. In a meta-analysis of vitamin E supplementation trials in NAFLD patients, Ji and colleagues report vitamin E supplementation optimizes liver enzyme levels.  Blood vitamin E concentrations are not reported. It isn’t known if low levels of serum and tissue vitamin E concentrations may contribute to the disease.

It is known that 60% of Americans are not consuming the estimated average requirement (EAR) for  vitamin E.  Translation: almost 100% are not consuming recommended dietary allowance (RDA) for vitamin E (15 mg/d for everyone over 14y of age). Children with NAFLD have a diet that is insufficient in vitamin E which may contribute to the pathophysiology (Vos et al, 2012).

So what is the takehome message? Vitamin E intakes are significantly less than recommended. The prevalence of severe obesity and NAFLD are increasing. Vitamin E supplementation to patients with NAFLD seems beneficial.

It would be helpful to know serum vitamin E concentrations in healthy individuals, those at risk of NAFLD, and those with NAFLD. Based on a nationally representative NHANES data, 62.5% of American adults (> 20y) have serum α-tocopherol concentrations below 30 µmol/L  - the level at which risk of a cardiovascular event was lowest  in the Alpha-Tocopherol Beta-Carotene study. Among Americans who did not self-report using dietary supplements, >80% were below the 30 µmol/L cutoff. Vitamin E status differed by age. Amongst non-supplement users, the prevalence of serum α-tocopherol below 30 µmol/L among 20-30y, 31-50y and 51+ y was 92.7%, 80.8% and 71.2%, respectively.

Americans are not consuming enough vitamin E. Vitamin E is a nutrient of concern.

Main Citation

Musso G, Gambino R, Tabibian JH, Ekstedt M, Kechagias S, Hamaguchi M, Hultcrantz R, Hagstrom H, Yoon SK, Charatcharoenwitthaya P, George J, Barrera F, Haflioadottir S, Bjornsson ES, Armstrong MJ, Hopkins LJ, Gao X, Francque S, Verrijken A, Yilmaz Y, Lindor KD, Charlton M, Haring R, Lerch MM, Rettig R, Volzke H, Ryu S, Li G, Wong LL, Machado M, Cortez-Pinto H, Yasui K, Cassader M. Association of non-alcoholic fatty liver disease with chronic kidney disease: A systematic review and meta-analysis. 2014 PLoS Med doi: 10.1371/journal.pmed.1001680

Other Citations

Kitahara CM, Flint AJ, Berrington de Gonzalez A, Bernstein L, Brotzman M, MacInnis RJ, Moore SC, Robien K, Rosenberg PS, Singh PN, Weiderpass E, Adami HO, Anton-Culver H, Ballard-Barbash R, Buring JE, Freedman DM, Fraser GE, Beane Freeman LE, Gapstur SM, Gaziano JM, Giles GG, Håkansson N, Hoppin JA, Hu FB, Koenig K, Linet MS, Park Y, Patel AV, Purdue MP, Schairer C, Sesso HD, Visvanathan K, White E, Wolk A, Zeleniuch-Jacquotte A, & Hartge P (2014). Association between Class III Obesity (BMI of 40-59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies. 2014 PLoS Med doi: 10.1371/journal.pmed.1001673

Burch D. Does diagnosing fatty liver and chronic kidney disease do more good than harm? 2014 PLoS Med doi: 10.1371/journal.pmed.1001681

Ji H-F, Sun Y, Shen L. Effect of vitamin E supplementation on aminotransferase levels in patients with NAFLD, NASH, and CHC: Results for a meta-analysis. 2014 Nutr doi: 10.1016/j.nut.2014.01.016

Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: Where do Americans get their nutrients? 2011 J Nutr doi: 10.3945/jn.111.142257

Vos MB, Colvin R, Belt P, Molleston JP, Murray KF, Rosenthal P, Schwimmer JB, Tonascia J, Unalp A, Lavine JE. Correlation of vitamin E, uric acid, and diet composition with histologic features of pediatric NAFLD. 2012 J Pediatr Gastroenterol Nutr doi: 10.1097/MPG.0b013e318229da1a

Pacana T, Sanyal AJ. Vitamin E and nonalcoholic fatty liver disease. 2012 Curr Opin Clin Nutr Metab Care doi: 10.1097/MCO.0b013e328357f747

McBurney M, Yu E, Ciappio E, Bird J, Eggersdorfer M, Stoecklin E, Mehta S. Vitamin E status of the US adult population by use of dietary supplements (1041.7). 2014 FASEB J. 28(1) 1041.7