Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease

Abstract

AIMTo determine the clinical effectiveness of nutritional counseling on reduction of non-alcoholic fatty liver disease (NAFLD) severity, weight loss, metabolic and anthropometric indexes and liver enzymes.METHODSForty-six adults with NAFLD received a 6-mo clinical and a dietary intervention (based on Mediterranean diet) carried out respectively by a gastroenterologist and a nutritionist with counseling license. The counseling process consisted of monthly meeting (about 45 min each). The effect of the treatment was evaluated monitoring liver enzymes, metabolic parameters, cardiovascular risk indexes, NAFLD severity [assessed by ultrasound (US)] and related indexes. All parameters were assessed at baseline. Biochemistry was also assessed at mid- and end-interventions and US was repeated at end-intervention.RESULTSThe percentage of patients with steatosis grade equal or higher than 2 was reduced from 93% to 48% and steatosis regressed in 9 patients (20%). At the end of the treatment the end-point concerning the weight (i.e., a 7% weight reduction or achievement/maintenance of normal weight) was accomplished by 25 out of 46 patients (i.e., 54.3%). As far as the liver enzymes is concerned, all three liver enzymes significantly decrease during the treatment the normalization was particularly evident for the ALT enzyme (altered values reduced from 67% down to 11%). Several parameters, i.e., BMI, waist circumference, waist-to-hip ratio, AST, ALT, GGT, HDL, serum glucose, Tot-Chol/HDL, LDL/HDL, TG/HDL, AIP, HOMA, FLI, Kotronen index, VAI, NAFLD liver fat score and LAP, showed a significant improvement (P < 0.01) between baseline and end-treatment.CONCLUSIONOutcomes of this study further strengthen the hypothesis that MedDiet and more active lifestyle can be considered a safe therapeutic approach for reducing risk and severity of NAFLD and related disease states. The proposed approach may be proposed as a valid and recommended approach for improving the clinical profile of NAFLD patients.

High‐Quality Diets Are Associated With Reduced Risk of Hepatocellular Carcinoma and Chronic Liver Disease: The Multiethnic Cohort

“…Fruit and vegetable intake is associated with higher dietary vitamin E and D, with vitamin E influencing lower levels of liver steatosis and inflammation and vitamin D decreasing inflammation and increasing glucose and lipid metabolism. The inverse association between the Mediterranean diet and NAFLD reported by prior studies and with HCC incidence in the MEC Latinos in the current study is important to note given the high prevalence of NAFLD in Latinos and the large fraction of NALFD‐associated HCC among Latinos …”

Exercising the hepatobiliary‐gut axis. The impact of physical activity performance

“…60 Reducing weight by ≥10% can contribute to the nonalcoholic steatohepatitis (NASH) resolution and fibrosis improvement, while a modest weight loss >5%-7% also produces important benefits on the components of the NAFLD activity score. 62,66,67 The genetic background of patients (ie, PNLPA3 gene polymorphism) is part of the lifestyle response in patients with NAFLD. 52,62 However, when comparing interventions of diet alone vs physical activity alone vs diet plus physical activity, the latter induces the greatest changes in obesity, 63,64 insulin resistance 65 and NAFLD.…”

“…52,62 However, when comparing interventions of diet alone vs physical activity alone vs diet plus physical activity, the latter induces the greatest changes in obesity, 63,64 insulin resistance 65 and NAFLD. 62,66,67 The genetic background of patients (ie, PNLPA3 gene polymorphism) is part of the lifestyle response in patients with NAFLD. 68,69 Previous individual trials suggest that moderate aerobic exercises is associated with decreased serum levels of liver enzymes.…”

A Regionalized Genome-Based Mexican Diet Improves Anthropometric and Metabolic Parameters in Subjects at Risk for Obesity-Related Chronic Diseases

“…Notably, compared to a large number of studies examining the benefits of traditional diets such as the widely recommended Mediterranean diet [23,24], there are very few studies evaluating the health effects of the traditional Mexican diet [25][26][27]. Therefore, this study aimed first to evaluate the effects of a regionalized GENOMEX diet on biochemical and anthropometric parameters and, subsequently, their relationship with the genetic profile of DRAG polymorphisms in subjects with metabolic risk factors for obesity-related CD.…”