Association between Non-Alcoholic Fatty Liver Disease and Mediterranean Lifestyle: A Systematic Review

Abstract

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is an excessive accumulation of fat in the liver without alcohol abuse. It is linked to metabolic syndrome (MetS) and no pharmacological treatment exists. This systematic review aims to assess evidence about the effect of Mediterranean lifestyle on the prevention and reversion of NAFLD. Methods: A systematic literature search was performed in MEDLINE via Pubmed. MeSH terms used were: non-alcoholic fatty liver disease [MeSH Major Topic] AND metabolic syndrome [MeSH Term] AND (Diet, Mediterranean [MeSH Term]) OR (Exercise [MeSH Term]). (PROSPERO ID: 2021 CRD42021289495). Results: Thirteen articles were selected and divided into two categories (four focused on Mediterranean diet and NAFLD and nine focused on Mediterranean diet, physical activity, and NAFLD). Information of clinical endpoints was based on NAFLD, as well as MetS, body mass index, fasting glycemia, obesity, cholesterol, triglycerides, transaminases, albuminuria, and hepatic steatosis, among others. All studies found beneficial associations between the clinical parameters of NAFLD/MetS and following a Mediterranean diet and regular physical activity. Conclusions: An effective treatment that prevents, and even reverses, NAFLD is to adapt lifestyle to the Mediterranean one, based on a Mediterranean diet and regular physical activity.

Association between Physical Activity and Non-Alcoholic Fatty Liver Disease in Adults with Metabolic Syndrome: The FLIPAN Study

“…Weight loss and histological improvement of the liver damage was associated with the decrease of GGT levels [ 35 ]. As it has already seen, a Mediterranean lifestyle, following a low-calorie Mediterranean diet and regular PA, was associated with weight loss and improvement of MetS parameters in NAFLD patients [ 10 ]. Therefore, it confirms the current hypothesis that higher PA, considering the sociodemographic characteristics as confounders, may act as a protective factor against high GGT levels in NAFLD patients.…”

“…It decreases high plasma triglyceride levels, weight, and blood pressure, as well as regulates low plasma high-density lipoprotein (HDL)-cholesterol levels. It improves type 2 diabetes mellitus and MetS [ 10 ].…”

Effect of Dietary and Lifestyle Interventions on the Amelioration of NAFLD in Patients with Metabolic Syndrome: The FLIPAN Study

“…Physical activity sessions of 35 min consisted of 5 min warm-up, 20 min interval training, and 10 min breathing and stretching. It has been pointed out that an association between physical activity and risk of nonalcoholic fatty liver disease, and people with NAFLD showed low levels of PA [ 18 ]. Three to five sessions per week of moderate or vigorous physical activity, an equivalent of 150–200 min per week, have been shown to decrease the development of NAFLD [ 19 ].…”

Impact of Physical Activity Differences Due to COVID-19 Pandemic Lockdown on Non-Alcoholic Fatty Liver Parameters in Adults with Metabolic Syndrome

“…Currently, it affects up to 30% of the population and it is also considered a metabolic syndrome (MetS) manifestation [1,2]. NAFLD results in the deposition of fat in hepatocytes and it can progress to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis and carcinoma [3,4] in the absence of excessive drug and/or alcohol consumption [5]. There is no pharmacological treatment for NAFLD, so the best existing treatment is lifestyle modification with a Mediterranean diet and physical activity (PA), as well as the treatment of each of the metabolic complications [6,7].…”