Clinics in Medicine and Medical Research | Volume 4, Issue 1 | Research Article | Open Access
Loso Judijanto*
IPOSS Jakarta, Indonesia
*Correspondence to: Loso Judijanto
Fulltext PDFMetabolic dysfunction-associated steatotic liver disease (MASLD) is a highly prevalent metabolic liver disorder encompassing steatosis, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Its pathogenesis involves systemic insulin resistance, dysfunctional adipose tissue, increased hepatic fatty-acid delivery, de novo lipogenesis, lipotoxicity, mitochondrial and endoplasmic-reticulum stress, oxidative injury, adipokine imbalance, inflammation, hepatocyte death, and fibrogenesis. Palm-derived tocotrienols, members of the vitamin-E family, are of growing interest because their unsaturated side chains and isoform-specific biological properties may confer antioxidant, anti-inflammatory, lipid-regulatory, insulin-sensitizing, and cytoprotective effects that address several MASLD mechanisms concurrently. This critical qualitative review integrates recent mechanistic, translational, and clinical evidence concerning tocotrienols in MASLD. Randomized studies suggest that δ-tocotrienol can improve fatty liver indices, insulin resistance, hepatic enzymes, oxidative-stress markers and inflammatory biomarkers, while potentially altering leptin, adiponectin, cytokeratin-18 and disease-associated circulating microRNAs. Nevertheless, current evidence does not establish regression of clinically important fibrosis or prevention of liver-related outcomes. Small samples, limited phenotypic diversity, inconsistent formulations, and dependence on surrogate endpoints remain major limitations. Future trials should incorporate MRI-PDFF, elastography or magnetic resonance elastography, validated fibrosis biomarkers, histology where appropriate, metabolic phenotyping, pharmacokinetic characterization, and longer follow-up. Palm tocotrienols should therefore be regarded as promising adjunctive candidates rather than established MASLD therapeutics.
Metabolic dysfunction-associated steatotic liver disease; MASLD; MASH; Tocotrienols; Palm oil; δ-tocotrienol; Insulin resistance; ipotoxicity; Adipokines; Hepatic fibrosis
Loso Judijanto. Palm-Derived Tocotrienols in Metabolic Dysfunction-Associated Steatotic Liver Disease: From Lipotoxicity and Insulin Resistance to Adipokine Remodeling, Inflammation, and Clinical Translation. Clin Med and Med Res. 2026;4(1):1-24.