Relationship between the Mediterranean diet and risk of hepatic fibrosis in patients with non-alcoholic fatty liver disease: A cross-sectional analysis of the RaNCD cohort

Abstract

BackgroundDespite evidence supporting the beneficial effects of the Mediterranean diet (MedDiet) on hepatic steatosis in subjects with non-alcoholic fatty liver disease (NAFLD), the relationship of the MedDiet with hepatic fibrosis is as yet unclear. The aim of the present study was to explore this association in Iranian adults with NAFLD.MethodsThis cross-sectional study included 3,325 subjects with NAFLD from the Ravansar Noncommunicable Disease (RaNCD) cohort. Dietary intake data were collected by a validated food frequency questionnaire (FFQ). The MedDiet score was computed based on a nine-point scale constructed by Trichopoulou et al. Fatty liver index (FLI) and fibrosis-4 (FIB-4) index were used to predict hepatic steatosis and fibrosis in the population. Multivariate regression models were applied to determine associations.ResultsSubjects in the highest tertile of MedDiet score had a higher platelet and a lower weight, total cholesterol (TC), LDL-c, and FLI than those in the lowest tertile (p-value < 0.05). Adherence to the MedDiet was associated with a 7.48 (95%CI: 5.376 to 9.603; p-value: 0.001) × 103/μl; −0.417 (95%CI: −0.819 to −0.014; p-value: 0.042) kg, −2.505 (95%CI: −3.835 to −1.175; p-value: 0.001) mg/dl; and −1.93 (95%CI: −2.803 to −1.061; p-value: 0.001) mg/dl change in platelet, weight, TC, and LDL-c for each SD increase in the score, respectively. A significant linear trend was observed in odds of hepatic fibrosis across the tertiles of the MedDiet score (P-trend: 0.008). This linear trend was attenuated but remained significant after the adjustment of the relevant confounders (P-trend: 0.032). Adherence to the MedDiet was independently associated with about 16% lower odds of having hepatic fibrosis in patients with NAFLD for each SD increase in the score.ConclusionAdherence to the MedDiet characterized by a high intake of whole grains, fruits, vegetables, legumes, nuts, and fish was associated with a lower risk of having hepatic fibrosis in patients with NAFLD. Further studies are required to elucidate the causal relationship of observed association in individuals of all ages, ethnicities, and etiologies of hepatic steatosis.

Dietary inflammatory index in relation to the progression of hepatic steatosis and liver fibrosis: evaluation by elastography/Fibroscan

“…In another cross-sectional data consisting of 5,506 participants in the NHANES from 2005 to 2016 showed that adherence to diets with high DII scores was significantly associated with the increased risk of liver fibrosis measured by NFS [ 30 ]. Previous investigations revealed adherence to Mediterranean diets is linked to a lower risk of the liver fibrosis in patients with NAFLD [ 31 ]. The Mediterranean diets are rich in nutrients and foods with anti-inflammatory potential, such as white meats, vegetables, vegetable oils, fresh fruits, nuts, and low-fat dairy products [ 32 , 33 ].…”

Lifestyle Modification: Evaluation of the Effects of Physical Activity and Low-Glycemic-Index Mediterranean Diet on Fibrosis Score

“…In the LGIMD arm, kPa tended to decrease gradually up to 90 days without ever increasing from baseline. Myrian et al confirmed in their study that adhering to a Mediterranean diet program reduces the risk of fibrosis in subjects with NAFLD [ 9 ]. MD helps to improve metabolic health and weight control thanks to an increased intake of whole grains, fruits, vegetables, legumes, nuts, and fish and a reduced intake of red and processed meats and dairy products [ 9 ].…”

“…Myrian et al confirmed in their study that adhering to a Mediterranean diet program reduces the risk of fibrosis in subjects with NAFLD [ 9 ]. MD helps to improve metabolic health and weight control thanks to an increased intake of whole grains, fruits, vegetables, legumes, nuts, and fish and a reduced intake of red and processed meats and dairy products [ 9 ]. The high fiber content of MD has been shown to protect against becoming overweight or obese by reducing feelings of hunger, as well as through calorie density due to its low glycemic index [ 36 ].…”

“…A weight loss of 10% or more has shown an improvement of fibrosis when a PA program is included [ 8 ]. Recently, the association between a Mediterranean diet (MD) and the risk of liver cirrhosis has been identified by a population-based study in adults with NAFLD [ 9 ]; the results evidenced significatively better metabolic control with a high adherence to MD. In obese subjects, an improvement of fibrosis has been shown with weight loss [ 8 ]; weight is considered an independent predictor for progression of steatosis to liver fibrosis in NAFLD [ 10 ].…”

NAFLD Fibrosis Progression and Type 2 Diabetes: The Hepatic–Metabolic Interplay

“…Data from several observational studies indicated that adherence to the Mediterranean diet was associated with a lower risk of hepatic fibrosis [101][102][103]. The Med-Diet score appeared to be negatively correlated with markers of liver fibrosis (N-terminal pro-peptide of type III collagen (PRO-C3)) [104].…”