Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease.
OBJECTIVE
Nutrition has been proposed as a potential environmental factor affecting the risk of non-alcoholic fatty liver disease (NAFLD). In the present study, the impact of adherence to the Mediterranean diet (MD) on the presence and severity of NAFLD was explored.


METHODS
Seventy-three consecutive adult patients with recent NAFLD diagnosis were included. Adherence to the MD was estimated with MedDietScore. Demographic and anthropometric data, body composition analysis and several biochemical and inflammatory markers were estimated. Liver stiffness measurements by transient elastography were available in 58 patients and liver biopsies in 34 patients. Fifty-eight patients were matched with 58 healthy controls in terms of age, sex and body mass index.


RESULTS
MedDietScore was negatively correlated to patients' serum alanine aminotransferase (p = 0.03) and insulin levels (p = 0.001), insulin resistance index (p = 0.005) and severity of steatosis (p = 0.006) and positively to serum adiponectin levels (p = 0.04). Patients with non-alcoholic steatohepatitis (NASH) exhibited lower adherence to MD (29.3 ± 3.2 vs. 34.1 ± 4.4, p = 0.004) compared to those with simple fatty liver. Logistic regression analysis revealed that one unit increase in the MedDietScore was associated with 36% lower likelihood of having NASH (odds ratio: 0.64, 95% confidence interval: 0.45-0.92), after adjusting for sex and abdominal fat level. No difference in the MedDietScore was observed between patients and controls.


CONCLUSIONS
Higher adherence to the Mediterranean diet is not associated with lower likelihood of having NAFLD, but it is associated with less degree of insulin resistance and less severe liver disease among patients with NAFLD.
Department of Nutrition & Dietetics, Harokopio University, El. Venizelou 70, Kallithea, 17671 Athens, Greece. Electronic address: mkont@hua.gr.
Meropi D
MD
Kontogianni
Department of Nutrition & Dietetics, Harokopio University, El. Venizelou 70, Kallithea, 17671 Athens, Greece. Electronic address: nafsika.tileli@gmail.com.
Nafsika
N
Tileli
2nd Department of Internal Medicine, Athens University Medical School, Hippokration Hospital of Athens, Greece. Electronic address: katerina.marg@gmail.com.
Aikaterini
A
Margariti
Department of Nutrition & Dietetics, Harokopio University, El. Venizelou 70, Kallithea, 17671 Athens, Greece. Electronic address: mihalis.georgoulis@gmail.com.
Michael
M
Georgoulis
2nd Department of Internal Medicine, Athens University Medical School, Hippokration Hospital of Athens, Greece. Electronic address: meladeut@gmail.com.
Melanie
M
Deutsch
Laboratory of Histology & Embryology, Medical School, National & Kapodistrian University of Athens, Greece. Electronic address: dtiniak@med.uoa.gr.
Dina
D
Tiniakos
Department of Nutrition & Dietetics, Harokopio University, El. Venizelou 70, Kallithea, 17671 Athens, Greece. Electronic address: efragop@hua.gr.
Elisabeth
E
Fragopoulou
2nd Department of Internal Medicine, Athens University Medical School, Hippokration Hospital of Athens, Greece. Electronic address: rodza@mycosmos.gr.
Rodessa
R
Zafiropoulou
Department of Nutrition & Dietetics, Harokopio University, El. Venizelou 70, Kallithea, 17671 Athens, Greece. Electronic address: manios@hua.gr.
Yannis
Y
Manios
2nd Department of Internal Medicine, Athens University Medical School, Hippokration Hospital of Athens, Greece. Electronic address: gepapath@med.uoa.gr.
George
G
Papatheodoridis
D052242:Adiponectin / Q000097:blood; D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001823:Body Composition; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D010349:Patient Compliance; D055105:Waist Circumference; D055815:Young Adult
D052242:Adiponectin; D007328:Insulin; D000410:Alanine Transaminase
Inflammatory markers; Liver biopsy; Mediterranean diet; Transient elastography