Treatment Strategies for Nonalcoholic Fatty Liver Disease (NAFLD) Include Lifestyle Modifications and a Major Role of Vitamin D. A Randomized Controlled Trial

Aims: hypovitaminosis D may be related to the pathogenesis of the nonalcoholic fatty liver disease (NAFLD) and may contribute to NAFLD's development and progression. Our study aimed to evaluate the therapeutic effects of vitamin D supplementation in patients with NAFLD.

Place and Duration of Study: Department of Gastroenterology, Affiliated Hospital of Inner Mongolia University for the Nationalities, China, between January 2020 and September 2020.

Methods: A total number of 166 patients were randomly divided into treatment group (n=86) and control group (n=80) with elevated levels of AST (aspartate aminotransferase) and ALT (alanine aminotransferase) with hypovitaminosis D, with high or normal levels of T.G. (triglyceride), TCHO (total cholesterol), LDL-C (low-density lipoprotein C), HDL-C (high-density lipoprotein C). The treatment group received vitamin D 400 units twice a day along with lifestyle modifications as SMT (standard medical Treatment) (vitamin D+SMT), and the control group only received lifestyle modifications (SMT) for 6 months. The study's primary objective was to assess an improvement in elevated serum AST, ALT, T.G., TCHO, LDL-C, HDL-C, and the secondary purpose was to observe whether vitamin D can improve hypovitaminosis D in the patients with NAFLD.

Results: after 6 months of the treatment with vitamin D supplementation, a significant improvement in serum AST and ALT was observed in treatment group (vitamin D+SMT) when they were compared with control group (SMT) as, (ALT: vitamin D+SMT, 57.635±4.882 and 57.581±4.817(u/l) p value=0.033 vs SMT, 59.958±5.715 and 59.909±5.690(u/l) p value=0.07) and AST (AST: vitamin D+SMT, 46.920±4.162 and 46.864±4.145(u/l) p value=0.03 vs SMT, 50.270±4.060 and 50.256±4.053(u/l) p value=0.117). An improvement in vitamin D levels were observed only in treatment group (vitamin D+SMT) as, (VD: vitamin D+SMT, 20.985±3.732 and 21.049±3.684 (ng/ml) p value= 0.014 and SMT, 26.665±1.534 and 26.594±1.484 (ng/ml) p value=0.011).

Conclusion: In the patients with NAFLD, administration of vitamin D supplementation and lifestyle modifications can significantly improve serum ALT, AST, and vitamin D levels.