and E have been found to have both protective and therapeutic effects on NAFLD in an animal model (3, 4). This effect has been linked to the anti-oxidative function of these two vitamins. Nevertheless no medication has been definitively established for NAFLD and research has tried different free-radical scavengers and antioxidant agents. N-acetylcysteine (NAC) is frequently utilized where intracellular oxidant-antioxidant balance is concerned. NAC has a protective effect against liver injury in rats (5-8). One study has reported improvement of liver histopathology and reduction of oxidative stress by NAC in non-alcoholic fatty steatosis (NASH) in a rat model (9). A recent study has reported a significant decrease in liver steatosis and fibrosis in patients with NASH receiving Metformin and NAC (10). In this study, the significance of treatment with NAC in patients with NAFLD and with elevated liver enzymes has been investigated. Materials and methods This study was carried out in the clinics of Tabriz University of Medical Sciences during 2008 and the protocols were approved by the Ethical Committee of this University. Patients with ongoing NAFLD were included in this study and received either NAC (600 mg per 12 hours) or vitamin C (1000 mg per 12 hours). Patients with a diagnosis of NAFLD are commonly registered in this clinic. Patients would pick up a ticket from a box containing mixed labels of two different treatments, twenty from each category. Data collection was stopped when fifteen patients completed the treatment and the follow-up procedures. Most of the patients were referred because of elevated liver enzymes or a report of fatty liver in sonographic evaluation and some had non- specific complaints like abdominal discomfort. All patients gave their written consent. Patients received medication for medical conditions if necessary. The results of the clinical examination, the elevated level of liver enzymes, an ultrasonographic study of the liver and the exclusion of other etiologies for liver disease were the basis for the diagnosis of NAFLD. A detailed history was taken and patients with a history of alcohol consumption or the use of medications known to precipitate steatohepatitis, lipid-reducing agents, ursodeoxycholic acid or vitamin supplements in the 6 months prior to study were excluded. Laboratory evaluation in this study included serum liver tests: aspartate transaminase (AST), alanine Manouchehr Khoshbaten et al. 13 transaminase (ALT), and alkaline phosphatase (ALP). Further investigations included a hepatobiliary- system ultrasound, viral serology, autoantibody titers, serum iron, ferritin and transferrin saturation, ceruloplasmin and urine copper levels. Serological tests for hepatitis B, the antibody to the hepatitis C virus or autoantibodies, i.e., antinuclear antibody (ANA), antimitochondrial antibodies (AMA), anti- smooth muscle antibody (ASMA), and antibodies to liver-kidney microsome (anti-LKM), were negative in all patients. Serum electrolytes, urea, creatinine, fasting glucose, complete blood count, cholesterol and triglyceride levels were also obtained. An ion profile, α1-antitripsine and serum ceruloplasmin levels were normal in all patients. Serum biochemistry and ultrasonographic measurement of the liver and the spleen were performed at entry and every month for the period of the study. Liver hemodynamics, the grade of steatosis and the size of the spleen were measured by the same radiologist, blinded to the treatment method of the patients. All data were expressed as the mean ± standard deviation (SD). A chi-squared test was used to compare qualitative variables and Student’s t-test was used to compare quantitative variables between the two groups of patients. A repeated-measures ANOVA and k-related-samples tests were used to compare the data before and during each treatment where appropriate. A P-value of 0.05 was considered statistically significant. Results Fifteen patients completed the study procedure and were available for a full follow-up in each group as described above. The study population included 6 males and 9 females treated with NAC and 5 males and 10 females treated with vitamin C. No adverse drug effects were reported during the study. The initial characteristics of the study population is described in Table 1.These two randomly selected groups were well matched as to body mass index (BMI), diabetes or hyperlipidemia, which was Table 1: The comparison between the two study groups regarding age and aspects of metabolic syndrome. NAC (n=15) Vitamin C (n=15) Mean age (SD) Body mass index Diabetes mellitus no(%) Hyperlipidemia no(%) Hypertension 40.1(12.4) 30.3(5.0) 1(6.7) 2(13.3) 1(6.7) 46.8(1.4) 33.2(6.7) 2(13.3) 1(6.7) 1(6.7) P 0.137 0.201 0.534 0.534 1.000 Hepatitis Monthly, Winter 2010; 10(1): 12-16