Outcome of Phlebotomy on Improvement of Liver Enzymes and Steatosis in Non-Alcoholic Fatty Liver Disease: A Randomized, Controlled Trial

Background Objective: Iron overload in the liver can potentially induce non-alcoholic fatty liver disease (NAFLD). In this study, we sought to evaluate the phlebotomy in NAFLD, and compare it with modified life style. Materials Methods: This randomized, single-blind, clinical trial was carried out to evaluate the efficacy of phlebotomy on liver enzymes and steatosis in NAFLD patients. Forty patients diagnosed with NAFLD were enrolled in the study. Patients were randomized into two groups, including twenty patients in the first group who were under daily consumption of 800 IU vitamin E with modified lifestyle, and the second group who administrated 400 ml phlebotomy at the baseline and fifth month of study alongside the modified lifestyle. Transient elastography (TE) was used to evaluate liver transaminases, hemoglobin, ferritin levels, and liver stiffness prior to and following the intervention. Chi-square and paired t-tests were used to analyze the data, using SPSS v18. Results: In each group, there were 14 men and 6 women. There was no statistically significant difference in demographic features. After the intervention, the mean liver stiffness of the control group increased from 10.38±2.65 kPa before the treatment to 11.40±6.58 kPa, which was not significantly different (P=0.463). The liver stiffness was 11.29±4.71 kPa in the intervention group before the treatment, which was reduced to 8.10±2.36 kPa after the treatment; however, the difference between pre and post-treatment values was statistically significant (P = 0.009). Before and after the treatment, there were no significant differences in the levels of liver enzymes between the two groups. Conclusion: Phlebotomy is a useful treatment for NAFLD patients, and decreased liver stiffness as cirrhosis complication.