This clinical study aims to explore the potential liver-protective effects of palm tocotrienol-rich fraction (a form of Vitamin E) in adults with alcoholic fatty liver disease (AFLD). A total of 26 participants aged 18 to 65 years with AFLD will be randomly assigned to receive either tocotrienol (200 mg twice daily) or a placebo for six months. Throughout the study, participants will undergo regular liver health assessments including blood tests, FibroScan, and FibroTest, alongside evaluations of oxidative stress and inflammation markers. The study aims to determine whether tocotrienol can help improve liver function and reduce alcohol-related liver damage. Findings from this trial may provide valuable evidence for future clinical studies and highlight the potential of Malaysian palm-based tocotrienol as a natural, supportive approach to liver health.

Recent evidence from preclinical studies has shown that tocotrienols, a unique form of Vitamin E derived from palm oil, possess strong antioxidant, anti-inflammatory, and hepatoprotective properties. These effects have been demonstrated in non-alcoholic fatty liver disease (NAFLD) models, suggesting their potential benefit in alcohol-related liver injury as well. However, clinical evidence in human AFLD populations remains limited. Therefore, this study seeks to investigate the efficacy and safety of palm tocotrienol-rich fraction supplementation in patients with AFLD.

This is a randomized, double-blind, placebo-controlled Phase II clinical trial involving 26 adult participants aged 18 to 65 years who have been clinically diagnosed with alcoholic fatty liver disease. Participants will be randomly assigned to either: Treatment group (n = 13): receiving palm tocotrienol-rich fraction soft gels (200 mg twice daily); or Placebo group (n = 13): receiving refined, bleached, and deodorised (RBD) palm olein soft gels (200 mg twice daily). The intervention period will last six months, with follow-up assessments every three months. Participants will complete structured questionnaires on alcohol consumption patterns, lifestyle, and dietary habits at each visit. Blood samples will be collected at baseline and follow-up visits to evaluate liver function tests (ALT, AST, GGT, ALP, bilirubin), oxidative stress markers, haematological parameters, and inflammatory biomarkers such as cytokines. Non-invasive liver assessments, including FibroScan and FibroTest, will be performed twice during the study to monitor changes in liver fat content, and stiffness levels.

This study aims to provide scientific evidence on the efficacy of tocotrienol-rich fraction in improving liver health among individuals with AFLD. If proven effective, tocotrienol may represent a safe therapeutic option for mitigating alcohol-induced liver injury. The findings will also contribute to the development of evidence-based nutraceutical applications of palm tocotrienol and support efforts to diversify and add value to Malaysia's palm oil industry through health-promoting innovations. Moreover, the results will serve as baseline data for larger-scale clinical trials and future research into tocotrienol's broader therapeutic potential.

Inclusion Criteria:

1. Patients with history of alcoholic use disorder with clinical and biochemical evidence of alcoholic steatohepatitis (AST:ALT >2.0, elevated GGT)
2. Patients with Maddrey's discriminant function ≤ 32, and do not require the treatment of corticosteroid therapy or pentoxifylline.
3. Patients aged 18 to 65
4. Patients who could comply with alcohol abstinence.

Exclusion Criteria:

1. Severe alcoholic hepatitis defined as Maddrey's discriminant function >32

2. Patients with other concomitant liver diseases:

   1. Hepatitis B
   2. Hepatitis C
   3. Non-alcoholic fatty liver disease (NAFLD)
   4. Autoimmune hepatitis (AIH)
   5. Hereditary hemochromatosis

3. Patients who are obese (a BMI of 30 kg/ m2 or more) and with metabolic syndromes

4. Patients with bleeding disorders and who have been on anticoagulant or antiaggregant treatments

5. Patients who have been on corticosteroid therapy or pentoxifylline for alcoholic hepatitis

6. Patients with hepatocellular carcinoma

7. Pregnant patients

8. Patients who are breastfeeding

9. Patients with Childs C liver cirrhosis

10. Patients who have pyridoxine allergy or history

11. Patients who are judged by investigator that participation of the study is difficult due to disease as follow; hepatic cirrhosis, Wilson's disease, malignant tumor, serious metabolic disease, severe renal disease, severe pulmonary disease, severe cardiovascular disease, severe nervous disease/psychiatric disorder, muscle disease and etc.

12. Patients taking vitamin E, herbal supplements, or other investigational products within 90 days prior to the participation in the study.

13. Patients who have been taken any medications that could affect the treatment: hypoglycemic agents, colchicine, penicillamine, corticosteroids, ursodeoxycholic acid, pentoxifylline, long-term use of NSAIDs, statins, neuroleptics, anticonvulsant medications, high-dose acetaminophen(>=2.5g/day)

14. Patients who have received treatment that may affect liver function within 1 month prior to the participation in the study

15. Patients who could not comply with alcohol abstinence.

16. Patient who considered ineligible for participation in the study as Investigator's judgment

All IPD that underlie results in a publication

For the purpose of assigning participants to interventions, each subject was assigned a unique identification number. The researcher who generated the random allocation sequence and assigned participants was masked to the participants' clinical data and was independent of those involved in participant enrolment. Both researchers and participants were masked to the assigned treatment.