EFSA Calls for Review of Vitamin E Dietary Reference Values

20 Jul 2015 --- The European Food Safety Authority (EFSA) has concluded that the current Recommended Daily Amount (RDA) of vitamin E should be replaced by a newly defined Adequate Intake (AI). DSM is responding to this by highlighting the most recent scientific studies not broadly recognized yet, as well as emphasizing that more research into the micronutrient is needed to precisely define the vitamin E requirement in humans.

In particular, this includes the role of vitamin E in protecting polyunsaturated fatty acids (PUFAs) from being oxidized in cell membranes and the beneficial effect of adequate blood levels of vitamin E on cardiovascular health. The new research suggests that individual requirements vary in view of the critical interactions between vitamin E and PUFAs and differ for specific groups, such as pregnant and lactating women, as well as being dependent on factors such as age.

“Whilst we appreciate the work carried out by the EFSA panel in reviewing the Dietary Reference Values (DRV) for vitamin E, it is important to consider all scientific evidence when defining the value. This should include recent research that had been accepted by other well recognized agencies, such as the Institute of Medicine in the US and the D-A-CH report for Germany, Austria and Switzerland,” explains Prof. Manfred Eggersdorfer, Senior Vice-President, Nutrition Science & Advocacy at DSM and Professor for Healthy Ageing at the University of Groningen, The Netherlands.

“Achieving an optimal status of vitamin E is associated with a number of positive health benefits. Outcomes from the main epidemiological studies show a risk reduction of 24% for cardiovascular events, when comparing high versus low vitamin E concentrations. These results suggest a beneficial effect of vitamin E at a plasma concentration of 30 μmol/L. An increase of the intake recommendation would secure that the general population can reach this status.”

The recommended daily intake of vitamin E varies according to the age, gender and criteria applied in individual countries. In the European Union, adult recommendations previously ranged from 4 to 25mg a-tocopherol equivalents (a-TE)/day for men and from 3 to 12mg a-TE/day for women. The German-speaking countries (D-A-CH, 2013) have only recently set the recommendation at 12-15mg alpha-TE/day for men and 11-12 mg alpha-TE/day for women according to age. As part of its written response to the EFSA panel, DSM highlighted results from a number of observational, prospective studies which suggest that a serum tocopherol concentration of 30μmol/L and above has beneficial effects on human health in the field of cardiovascular disease and some cancers.

Vitamin E is a powerful antioxidant and carries an approved EFSA health claim for ‘contributing to the protection of cells from oxidative stress.’ Emerging data also suggest that vitamin E in higher doses holds promise beyond these recognized benefits of vitamin E as an essential nutrient. For selected individuals and population groups, vitamin E is understood to help maintain cognitive function in those at risk of Alzheimer’s disease and to help maintain liver and lung function in individuals who are overweight or exposed to air pollution.

“Intake of vitamin E is generally low in Europe. For example, the results of a micronutrient intake panel demonstrated that more than 75% of the population in the UK does not meet the recommended intake,” adds Prof. Eggersdorfer. “With individual needs varying depending on factors such as age, it may be more appropriate to consider a range of values rather than a fixed intake requirement.”

DSM also welcomes a new paper published in Nutrition that further examines the beneficial effect of vitamin E on non-alcoholic fatty liver disease (NAFLD), including non-alcoholic steatohepatisis (NASH). The aim of the meta-analysis was to evaluate the efficacy of vitamin E on improving liver function. It was concluded that vitamin E had significant results and there were obvious reductions in steatosis, inflammation and fibrosis in NASH adult patients, compared to the control treatment.

NAFLD, which encompasses a wide spectrum of disorders, has become a major health issue, as well as the most common liver disease throughout the world. Its prevalence is estimated at 20-30% of the general population, and as high as 70-80% in obese persons. The histologic pattern of NAFLD can progress to NASH, liver fibrosis, cirrhosis, and also hepatocellular carcinoma. Antioxidant therapy in the form of vitamin E has been considered to have beneficial effects in the management of NASH, but further work was required to fully understand the data. This analysis has a potentially major impact on public health because non-alcoholic fatty liver disease is also rated as risk factor for cardiovascular disease, diabetes type 2 and chronic kidney disease.

Vitamin E is often used in the treatment of NAFLD/NASH; however, the magnitude of response associated with vitamin E in improving liver function and histology in NAFLD/NASH has not been quantified systematically. In order to circumvent potential inaccuracies, very strict inclusion and exclusion criteria were set for the present study, and the list of relevant publications included in the meta-analysis was narrowed down to only five. The meta-analysis concluded that vitamin E therapy can result in decreased levels of liver damage related to hepatitis and cirrhosis in children and adults with NAFLD and NASH. Vitamin E therapy reduced significantly aspartate transaminase, alanine aminotransferase and alkaline phosphatase – key liver enzymes which are elevated in people with NAFLD and NASH – and was also shown to reduce steatosis, lobular inflammation, and even hepatocellular ballooning in the liver. The authors conclude that vitamin E significantly improved liver function.

“This meta-analysis will assist the medical community in better assessing the benefits of vitamin E in treating NAFLD/NASH, which could be used to help establish more accurate clinical guidelines for practitioners,” comments Dr. Manfred Eggersdorfer, Senior Vice President, Nutrition Science & Advocacy, DSM, and Professor for Healthy Ageing at University Medical Center Groningen.