The effects of Mediterranean diet on hepatic steatosis, oxidative stress, and inflammation in adolescents with non‐alcoholic fatty liver disease: A randomized controlled trial

Abstract

Summary Background Non‐alcoholic fatty liver disease (NAFLD) has become the most common liver disease in children and adolescents. The optimal dietary strategy to improve hepatic stetatosis and reduce oxidative stress and inflammation in adolescents is unknown. Objective This study was conducted to evaluate the effect of Mediterranean diet (MD) versus low‐fat diet (LFD) on hepatic steatosis, inflammation, and oxidative stress in adolescents with obesity and NAFLD. Methods Adolescents diagnosed with NAFLD between the ages of 11–18 years were randomized to either a MD or conventional LFD (control diet) for 12 weeks. Dietary status, anthropometry, body composition, and biochemical parameters were evaluated. Hepatic steatosis was determined by ultrasonography. Results A total of 44 participants completed the study. At the end of the study, severity of hepatic steatosis, serum transaminase levels, and insulin resistance decreased significantly in both groups with no significant differences between groups except for aspartate aminotransferase (AST). The amount of decrease in AST levels in the MD group was greater than the LFD group (p < 0.05). In the MD group, serum total antioxidant capacity, paraoxanase‐1, and glutathione peroxidase levels increased (p < 0.05); it did not change in the LFD group compared to baseline (p > 0.05). C‐Reactive Protein (CRP) levels decreased only in the MD group (p = 0.008), interleukine‐6 decreased only in the LFD group (p = 0.031). Conclusion Consumption of MD and LFD for 12 weeks in adolescents with obesity and NAFLD reduced BMI, fat mass, hepatic steatosis, and insulin resistance, improved high transaminase levels, and had positive effects on inflammation and oxidative stress. Registered under http://clinicaltrials.gov Identifier no. NCT04845373.

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“… 61 In addition, the clinical practice guidelines published by the European Association for the Study of the Liver, European Association for the Study of Diabetes, and European Association for the Study of Obesity recommended that the Mediterranean diet (MD) pattern, which contains high amounts of whole grains and monounsaturated fatty acids (MUFAs), as the first-choice diet for patients with NAFL/NASH. 62 MD showed improved hepatic steatosis and reduced visceral fat in patients with NAFL in both adults and adolescents, 63 , 64 and persistent MD might reduce the prevalence of NAFL and improve IR in patients with NAFL. 65 MD was also shown to reduce platelet activation and hepatic collagen deposition, reducing the risk of CVD in patients with NAFLD.…”

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“…The same mechanism also occurs in obese individuals. An important way that obesity causes low inflammation involves macrophage activation and migration, which can release various inflammatory factors such as interleukin and tumor necrosis factor, creating an inflammatory environment that blocks insulin from doing its job in fat cells and leading to IR, while the Mediterranean diet reportedly improved IR in NAFLD and obese patients, possibly by lowering their inflammation levels [ 45 , 46 ]. The systemic inflammatory response in patients with NAFLD is closely associated with CHD.…”

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“…An RCT including adolescents with NAFLD randomized to receive Med-Diet showed a significant improvement of liver function tests, hepatic steatosis, insulin resistance and oxidative stress after 12 weeks [ 96 ].…”