title: A modified Mediterranean diet is associated with the greatest reduction in alanine aminotransferase levels in obese type 2 diabetes patients: results of a quasi-randomised controlled trial.
abstract: OBJECTIVE
  The aim of the study was to compare the effect of different dietary interventions on alanine aminotransferase (ALT) in obese patients with diabetes.
  
  
  METHODS
  A post hoc analysis of an open label, parallel design, quasi-randomised (allocation by alternation), controlled trial, conducted in Israel. Obese patients with diabetes (n = 259), treated in the community, were centrally allocated to one of three diets: (1) the 2003 recommended American Diabetes Association diet (ADA): 50-55% carbohydrate, 30% fat and 20% protein, n = 85; (2) a low glycaemic index (LGI) diet: 50-55% LGI carbohydrate, 30% fat, 15-20% protein, n = 89; or (3) a modified Mediterranean diet (MMD): 35% LGI carbohydrate, 45% fat that was high in monounsaturated fat, 15-20% protein, n = 85. ALT was measured at 6 and 12 months.
  
  
  RESULTS
  ALT levels decreased in all arms; however, the MMD was associated with the lowest ALT levels at month 6 (n = 201: ADA n = 64, LGI n = 73, MMD n = 64) and month 12 of follow-up (n = 179). At 12 months mean ALT levels were 19.8 +/- 1.4 U/l in the ADA diet arm (n = 54), 18.0 +/- 1.5 U/l in the LGI diet arm (n = 64) and 14.4 +/- 1.7 in the MMD arm (n = 61, p < 0.001). Evidence for an effect of diet on ALT levels persisted when controlling for post-randomisation changes in waist to hip ratio, BMI, homeostasis model assessment (HOMA) or triacylglycerol.
  
  
  CONCLUSIONS
  A Mediterranean diet may have a beneficial effect on liver steatosis in obese patients with diabetes. Results of trials assessing the effect of dietary composition on clinical outcomes should be awaited before a decisive conclusion can be reached. In addition to clinical outcomes, such studies should address the issue of primary prevention of steatosis in high-risk and healthy individuals.
authors.affiliation: Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK. Abigail.fraser@bristol.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Fraser
authors.forename: R
authors.initials: R
authors.lastname: Abel
authors.forename: D A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: D
authors.initials: D
authors.lastname: Fraser
authors.forename: A
authors.initials: A
authors.lastname: Elhayany
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D049628:Body Size; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000178:diet therapy* / Q000628:therapy; D038441:Diet, Mediterranean; D004734:Energy Metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000178:diet therapy* / Q000201:enzymology; D000637:Transaminases / Q000097:blood*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids; D000637:Transaminases