Effects of Mediterranean Diet in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Randomized Controlled Trials

Abstract

We conducted a meta-analysis to investigate the effects of the Mediterranean Diet (Med-Diet) on hepatic steatosis and insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). Six randomized controlled trials were selected for the meta-analysis (sample size: 250 participants). In the meta-analysis, there was no significant difference in body mass index and waist circumference between the Med-Diet and control groups. Med-Diet significantly reduced fatty liver index (FLI) compared with the control diet (standard mean difference [SMD]: –1.06; 95% CI: –1.95 to –0.17; p = 0.02). Med-Diet significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) compared with the control diet (SMD: –0.34; 95% CI: –0.65 to –0.03; p = 0.03). Similarly, a meta-regression analysis using age showed that Med-Diet significantly reduced FLI and HOMA-IR (95% CI: –0.956 to –0.237, p = 0.001 and 95% CI: –0.713 to –0.003, p = 0.048, respectively). This meta-analysis demonstrated that Med-Diet improved hepatic steatosis and insulin resistance in patients with NAFLD. Thus, Med-Diet is a beneficial pharmaconutritional therapy in patients with NAFLD.

The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis

“…There was consistent evidence that MD interventions improved one or more measures of NAFLD activity and meta-analysis showed a significant effect on post-intervention ALT, FLI and LSM. This is consistent with recent reviews which concluded that MD interventions improved FLI [56], liver enzymes and NAFLD severity indices [57]. Very limited evidence suggested that individual components of MD such as wholegrains and olive oil may improve NAFLD surrogate markers [43e45], but meta-analysis revealed no significant effects.…”

Nutrition as Therapy in Liver Disease

“…The Mediterranean diet significantly reduced the fatty liver index (standardized mean difference, -1.06; CI, -1.95 to -0.17; P = 0.02), as well as the homeostasis model assessment of insulin resistance (standardized mean difference, -0.34; CI, -0.65 to -0.03; P = 0.03). 27 Another recent study compared the Mediterranean diet versus a "green-rich" Mediterranean diet to see the effect on hepatic fat. 28 The "green" group consumed green tea, Mankai, and a "green" shake on top of the typical isocaloric Mediterranean diet.…”

What should we advise MAFLD patients to eat and drink?

“…Interventional studies showed that consuming MD was associated with an improvement in liver enzymes, steatosis, liver stiffness, and lipid profile, even without weight loss [218][219][220][221][222][223][224][225][226][227] . We still need long-term trials to understand the role of MD on liver histopathology.…”