Considering the potential role of liver iron overload in the pathogenesis of Non-alcoholic fatty liver disease (NAFLD), the current study aimed at investigating the efficacy of phlebotomy versus lifestyle modification alone in patients with NAFLD.

This randomized, single-blind, clinical trial performed on 40 patients with NAFLD. Patients were randomly assigned into two intervention groups including 20 patients who underwent a six-month lifestyle modification, daily intake of 800 IU vitamin E. The other group received the same treatment in combination with two times phlebotomy each 400 mL in the months 0 and 5. Liver transaminases, hemoglobin and ferritin levels, and liver stiffness were measured using transient elastography (TE) before and after the intervention. Data were analyzed using Chi-square and paired t-test with SPSS version 18.

Of 20 patients in each group, 14 were male and 6 were female. Demographic characteristics had no significant difference between the two groups. The mean of liver stiffness in the control group before and after the intervention was 14.28 ± 9.85 and 14.94 ± 13.21 kPa, respectively; the difference between the means was not significant (P = 0.598). The liver stiffness was 17.04 ± 18.77 kPa in the intervention group before treatment, which reduced to 14.75 ± 14.28 kPa after treatment; however, the difference between pre- and post-treatment values was statistically significant (P = 0.017). Changes in liver enzymes were not significant between the two groups before and after treatment.

phlebotomy can effectively reduce liver stiffness in patients with NAFLD.