2017 -- Conference report inside the country
王又亮、鄭可家、孫子傑、張智仁、盧豐華、楊宜青、吳晉祥：補充維他命D對於非酒精性脂肪肝成人之代謝及發炎因子的影響–系統性回顧及統合分析 台灣家庭醫學醫學會106年度學術研討會會刊 P132-133.
Yu-Liang Wang, Ko-Chia Cheng, Zih-Jie Sun, Chih-Jen Chang, Feng-Hwa Lu1,, Yi-Ching Yang, Jin-Shang Wu: Vitamin D Supplement for Metabolic and Inflammatory Parameters in Adults with Non-alcoholic Fatty Liver Disease – a Systematic Review and Meta-Analysis
Non-alcoholic fatty liver disease (NAFLD) has been found to be associated with increased risk of cardiovascular disease, diabetes and liver related complications (such as non-alcoholic steatohepatitis or even cirrhosis). The association of low serum vitamin D level and increased risk of NAFLD has been found in previous studies. There were some randomized control trials to evaluate the effect of vitamin D supplement on some health-related indicators in NAFLD adults, but the systematic review and meta-analysis to investigate the effect of vitamin D supplement on metabolic and inflammatory parameters were limited in NAFLD adults. The aim of this study was to examine the efficacy of vitamin D supplement for metabolic and inflammatory parameters in adults with NAFLD based on meta-analysis.
We searched Medline (Ovid), Cochrane (CENTRAL) and Embase up to March 2017. The search strategies included randomized controlled trials from Cochrane hand book and only English literature. We included studies enrolling adults with either NAFLD or non-alcoholic steatohepatitis which were diagnosed by ultrasonography, histology or proton magnetic resonance spectroscopy (intrahepatic lipid > 5% or intrahepatic triglyceride concentration > 10%), computed tomography (liver/spleen ratio <1), or elevated alanine aminotransferase (ALT) level with excluding other liver disease. Subjects with other causes of liver injury, including alcoholic, drug-induced, total parenteral nutrition-induced, viral or genetic related lesions, were excluded. Intervention of the studies included all type of vitamin D supplement as compared with placebo. Uncontrolled trials were excluded from the final analysis. The target variables including ALT, aspartate aminotransferase (AST), Cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood sugar, insulin level, insulin resistance index (HOMA-IR) and C-reactive protein (CRP) level were analyzed in this study. Results: Six of 371 studies were included after systemic and reference research. Only four trials were included in meta-analysis, because two studies were overlapped. The pooled effect showed a significant decrease of HOMA-IR in vitamin D supplement group compared to placebo group(standard mean difference: -5.66, 95%CI:-8.59~-2.73, p<0.001) and a decline of insulin levels was also found (standard mean difference: -4.07, 95%CI:-6.62~ -1.52, p=0.002). Fasting blood sugar levels also revealed a significant decrease in vitamin D supplement group (standard mean difference: -0.98, 95%CI:-1.83 ~ -0.12, p=0.03). Based on the data of three studies, the beneficial effect of vitamin D supplement was also shown in CRP levels (standard mean difference: -2.15, 95%CI:-4.04 ~ -0.27, p=0.03).In the analysis of other parameters, lipid profile, including total cholesterol, triglyceride, HDL-C, and LDL-C, and liver enzyme, including AST and ALT, showed no significant benefit in vitamin D supplement group, as compared to placebo group.
Vitamin D supplement had an improvement in HOMA-IR, insulin level, fasting blood sugar in adults with NAFLD based on meta-analysis of randomized controlled trials. The benefit of vitamin D supplement was also found in CRP levels.