• In a multicenter randomized placebo-controlled trial, 200 IU/day natural vitamin E lowered ALT nearly as much as 400 IU/day and 800 IU/day in adults with suspected MASH and elevated aminotransferases.
• ALT normalization was more frequent with vitamin E than placebo, while liver fat and stiffness improved numerically but not significantly.
• Safety signals were not observed over 24 weeks, suggesting that a lower dose may preserve biochemical benefit while limiting theoretical dose-related risks.
