do symbiotic and vitamin e supplementation have favorite effects in nonalcoholic fatty liver disease? a randomized, double?blind, placebo?controlled trial

background: nonalcoholic fatty liver disease (nafld) is the most common chronic liver disease in the world. oral administration of symbiotic and vitamin e has been proposed as an effective treatment in nafld patients. this study was carried out to assess the effects of symbiotic and/or vitamin e supplementation on liver enzymes, leptin, lipid profile, and some parameters of insulin resistance (ir) in nafld patients. materials and methods: we randomly assigned sixty nafld adult patients to receive (1) symbiotic twice daily + vitamin e?like placebo capsule; (2) 400 iu/d vitamin e + symbiotic?like placebo; (3) symbiotic twice daily + 400 iu/d vitamin e; and (4) symbiotic?like placebo + vitamin e?like placebo for 8 weeks. results: symbiotic plus vitamin e supplementation led to a significant decrease in concentrations of liver transaminase (p ? 0.05). mean difference of apolipoprotein a?1 was more significant in symbiotic group compared to control. however, mean difference of apolipoprotein b100/a?1 was only significant in symbiotic group compared to control. at the end of the study, significant differences in total cholesterol (tc) and low?density lipoprotein cholesterol (ldl?c) were seen between the symbiotic plus vitamin e and control groups (p < 0.001). furthermore, intake of symbiotic plus vitamin e supplements led to a significant decrease in concentrations of triglycerides (tg) after the intervention. significant differences in leptin, fasting blood sugar (fbs), and insulin levels were seen between the symbiotic plus vitamin e and control groups at the end of the study (p < 0.001). in contrast, symbiotic and/or vitamin e supplementation did not affect high?density lipoprotein cholesterol and homeostasis model assessment for ir levels. conclusion: in our study, symbiotic plus vitamin e supplementation was the most effective treatment in lowering liver enzymes, leptin, fbs, insulin, tg, tc, and ldl?c among nafld patients.