Tsou Peiling, Wu Chang-Jiun
Department of Genomic Medicine, University of Texas, MD Anderson Cancer Center. 1901 East Road, 3SCR5.4101, Houston, TX 77054, USA.
J Clin Med. 2019 Jul 19;8(7):1057. doi: 10.3390/jcm8071057.
Nonalcoholic fatty liver disease (NAFLD) is a growing health threat worldwide. Vitamin E supplementation is recommended for nonalcoholic steatohepatitis (NASH) patients, but only for non-diabetic subjects. We aimed to investigate whether serum vitamin E levels differently impact long-term prognosis in diabetic versus non-diabetic NAFLD individuals. A total of 2404 ultrasonographically defined NAFLD individuals from National Health and Nutrition Examination Survey (NHANES) III were stratified by their glycemic statuses into diabetic ( = 662), pre-diabetic ( = 836) and non-diabetic ( = 906), and the relationship between serum vitamin E levels and all-cause mortality was analyzed. The serum vitamin E concentrations were 31.1 ± 14.1, 26.7 ± 9.6, and 24.7 ± 9.8 µmol/L and vitamin E: total cholesterol ratios were 5.16 ± 1.70, 4.81 ± 1.46, and 4.80 ± 1.34 µmol/mmol in in diabetic, pre-diabetic, and non-diabetic groups, respectively. Of 2404 NAFLD subjects, 2403 have mortality information and 152 non-diabetic, 244 pre-diabetic, and 342 diabetic participants died over a median follow-up period of 18.8 years. Both serum vitamin E levels and vitamin E: total cholesterol ratios were negatively associated with all-cause mortality after adjusting for possible confounders in non-diabetic subjects (HR = 0.483, and 0.451, respectively, < 0.005), but not in either diabetic or pre-diabetic subjects. In NAFLD individuals, both serum vitamin E and lipid-corrected vitamin E were (1) higher in the diabetic group; and (2) negatively associated with all-cause mortality only in the non-diabetic group. Further investigations are warranted to elucidate the underlying mechanism of this inverse association of serum vitamin E concentration with all-cause mortality in non-diabetic but not pre-diabetic or diabetic subjects.
非酒精性脂肪性肝病（NAFLD）在全球范围内对健康的威胁日益增加。对于非酒精性脂肪性肝炎（NASH）患者，推荐补充维生素E，但仅适用于非糖尿病患者。我们旨在研究血清维生素E水平对糖尿病与非糖尿病NAFLD个体的长期预后是否有不同影响。来自美国国家健康与营养检查调查（NHANES）III的总共2404名经超声检查确诊的NAFLD个体，根据其血糖状态分为糖尿病组（n = 662）、糖尿病前期组（n = 836）和非糖尿病组（n = 906），并分析血清维生素E水平与全因死亡率之间的关系。糖尿病组、糖尿病前期组和非糖尿病组的血清维生素E浓度分别为31.1±14.1、26.7±9.6和24.7±9.8μmol/L，维生素E与总胆固醇的比值分别为5.16±1.70、4.81±1.46和4.80±1.34μmol/mmol。在2404名NAFLD受试者中，2403人有死亡信息，在中位随访期18.8年期间，152名非糖尿病参与者、244名糖尿病前期参与者和342名糖尿病参与者死亡。在调整可能的混杂因素后，血清维生素E水平和维生素E与总胆固醇的比值在非糖尿病受试者中均与全因死亡率呈负相关（HR分别为0.483和0.451，P < 0.005），但在糖尿病或糖尿病前期受试者中并非如此。在NAFLD个体中，血清维生素E和经脂质校正的维生素E均：（1）在糖尿病组中较高；（2）仅在非糖尿病组中与全因死亡率呈负相关。有必要进行进一步研究以阐明血清维生素E浓度与非糖尿病而非糖尿病前期或糖尿病受试者的全因死亡率之间这种负相关的潜在机制。
