CoQ10 supplementation improves fatty liver, reduces markers of inflammation in NAFLD

Tuesday, July 21, 2015. On July 9, 2015, the Journal of the American College of Nutrition reported positive results for coenzyme Q10 (CoQ10) in a randomized, double-blind trial of men and women with nonalcoholic fatty liver disease (NAFLD), a disorder characterized by elevated serum liver enzyme levels, liver enlargement and fat accumulation in the liver, accompanied by increased inflammation.

"Recent evidence suggests that CoQ10 supplementation may be useful for improving and preventing pathological conditions such as metabolic syndrome, hypertension, diabetes, liver diseases, and insulin resistance," write Farmaz Farsi, MSc of Ahvaz Jundishapur University of Medical Sciences and colleagues. "Because there is no universal treatment for NAFLD, and due to the antioxidant and anti-inflammatory properties of CoQ10, we hypothesized that oral CoQ10 supplementation could be effective in managing NAFLD and preventing its progression."

The trial included 41 patients with mild to moderate NAFLD. Twenty one participants received a placebo and 20 participants received 100 milligrams CoQ10 once daily for 12 weeks. Liver enzymes, markers of inflammation including serum high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-a), adipokines and NAFLD grade (which is determined by the percentage of liver cells with fat droplets) were measured before and after the treatment period.

Among those who received CoQ10, serum hs-CRP and TNF-a levels were lower at the end of the trial in comparison with the placebo group as well as in comparison to the CoQ10 group's levels at the beginning of the study. Serum adiponectin (which has been associated with weight loss and other positive effects) was higher at the study's conclusion among those who received CoQ10 compared to those who received a placebo, and liver enzymes ALT, AST and GGT were lower at the end of the study compared to baseline levels in those given CoQ10.

NAFLD grade also improved among COQ10-supplemented subjects. While no patients were graded as normal prior to the intervention, four became normal after 12 weeks of CoQ10, in contrast with just one patient attaining this grade in the placebo group.

"CoQ10 supplementation might be considered a good adjuvant therapeutic option to attenuate systemic inflammation alongside other treatments for this disease," Dr Farsi and associates conclude. "Although this study verifies our hypothesis, long-term and larger studies are recommended to elucidate the potential mechanisms of CoQ10 therapy in patients with NAFLD and to confirm the present results."

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Meta-analysis adds evidence to protective effect for vitamin E against nonalcoholic steatohepatitis

A meta-analysis of randomized trials examining the effects of vitamin E supplementation in individuals with nonalcoholic steatohepatitis (NASH) affirmed a benefit for the vitamin in association with several facets of the disease. The analysis appeared this year in the International Journal of Clinical and Experimental Medicine.

"Non-alcoholic fatty liver disease (NAFLD) is characterized by fat accumulation in hepatocytes in the absence of significant alcohol intake," write Renfan Xu and colleagues at Huazhong University of Science and Technology. "The majority of patients with NAFLD have simple steatosis, which has a benign clinical outcome, whereas approximately 15%-20% of patients will progress to nonalcoholic steatohepatitis (NASH), which includes macrovesicular steatosis, hepatocyte ballooning, lobular inflammation and fibrosis and can develop into cirrhosis or even liver failure."

Dr Xu and associates selected three articles that met the criteria for their analysis, which included a total of 245 men and women with NASH. Trials involved daily supplementation with a placebo or vitamin E alone or in combination with other compounds. In the two studies that compared pretreatment to post-treatment histological factors, including steatosis (abnormal cellular retention of lipids), ballooning (a form of programmed cell death) and lobular inflammation, all were improved to a greater extent among those who received vitamin E by the end of the trials in comparison with the control groups. For all three trials, vitamin E supplementation was associated with improvement in fibrosis compared to controls.

"This meta-analysis revealed that vitamin E supplementation resulted in significant improvements in histological parameters in NASH patients," the authors conclude. "Additional large-scale high-quality studies are needed to investigate the effect of vitamin E supplementation on NASH patients with outcomes (histological parameters, biochemical variables and adverse events) oriented to obtain more comprehensive information on supplementation for clinical use."

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Health Concern

Nonalcoholic fatty liver disease

Roughly one-third of the American population suffers from nonalcoholic fatty liver disease or NAFLD (Polyzos et al 2010, Schuppan et al 2010, Younossi 2008). Many of its victims do not know they have it.

NAFLD is defined as deposition of fat in the liver cells of patients with minimal or no alcohol intake and with no other known cause (Lirussi et al 2007). The term "NAFLD" refers to a group of related and progressive conditions closely associated with overweight and obesity (Schuppan et al 2010).

Early NAFLD can ultimately progress to a more serious condition, nonalcoholic steatohepatitis or NASH (Musso et al 2010). About a third of people with NAFLD will develop NASH (Raszeja-Wyszomirska et al 2008), and about 20% of people with NASH will go on to liver fibrosis and cirrhosis, with its accompanying risk of liver failure and even liver cancer (Schuppan et al 2010, Raszeja-Wyszomirska et al 2008, Mark et al 2010).

NAFLD and NASH are progressive conditions that require patient collaboration with a qualified physician. Because the liver metabolizes many nutrients and drugs, it is important that liver patients not add any substances to their regimen without cooperation and close monitoring by a qualified physician. The goals of therapy are:

Reduce the accumulation of fat in liver tissue by decreasing new fat synthesis and increasing utilization of existing fat stores in the liver.
Minimize free radical production, and enhance free radical scavenging in liver tissue
Reduce or eliminate the inflammatory responses of fat-infiltrated liver tissue to prevent progression of NAFLD to the more deadly NASH, which is a precursor of liver failure.

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