Original Contribution | Published:

Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study

American Journal of Gastroenterology volume 96, pages 27112717 (2001) | Download Citation

M.F.A.'s current address: Section of Hepatobiliary Diseases, University of Florida, P.O. Box 100214, Gainesville, FL 32610




No effective therapy currently exists for patients with nonalcoholic steatohepatitis (NASH). Betaine, a naturally occurring metabolite of choline, has been shown to raise S-adenosylmethionine (SAM) levels that may in turn play a role in decreasing hepatic steatosis. Our aim was to determine the safety and effects of betaine on liver biochemistries and histological markers of disease activity in patients with NASH.


Ten adult patients with NASH were enrolled. Patients received betaine anhydrous for oral solution (Cystadane) in two divided doses daily for 12 months. Seven out of 10 patients completed 1 yr of treatment with betaine.


A significant improvement in serum levels of aspartate aminotransferase (p = 0.02) and ALAT (p = 0.007) occurred during treatment. Aminotransferases normalized in three of seven patients, decreased by >50% in three of seven patients, and remained unchanged in one patient when compared to baseline values. A marked improvement in serum levels of aminotransferases (ALT −39%; AST −38%) also occurred during treatment in those patients who did not complete 1 yr of treatment. Similarly, a marked improvement in the degree of steatosis, necroinflammatory grade, and stage of fibrosis was noted at 1 yr of treatment with betaine. Transitory GI adverse events that did not require any dose reduction or discontinuation of betaine occurred in four patients.


Betaine is a safe and well tolerated drug that leads to a significant biochemical and histological improvement in patients with NASH. This novel agent deserves further evaluation in a randomized, placebo-controlled trial.

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  1. Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA

    • Manal F Abdelmalek
    • , Paul Angulo
    • , Roberta A Jorgensen
    •  & Keith D Lindor
  2. Division of Surgical Pathology, Mayo Clinic and Foundation, Rochester, Minnesota, USA

    • Pamela B Sylvestre


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Correspondence to Keith D Lindor.

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