title: Mediterranean diet and non-alcoholic fatty liver disease: the need of extended and comprehensive interventions.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is mostly related to increased BMI and sedentary life, even if it not directly attributable only to these or to single specific factors. Unhealthy lifestyle and obesity are the most probable causes, also in non-diabetic and without alcohol abuse patients, even if lean individuals can be involved. NAFLD treatment is currently warranted and driven by comprehensive lifestyle intervention, a valuable objective that is more often wished for than actually achieved. The aim is to re-assess the effectiveness of an intervention focused to increase the Adherence to Mediterranean Diet Score (AMDS) and the level of physical exercise, investigating the factors associated with failure and reporting the time that must elapse before such intervention becomes effective.
  
  
  METHODS
  The study included 90 (F 46, M 44) non-alcoholic non-diabetic patients, aged 50.13 ± 13.68 years, BMI 31.01 ± 5.18 with evidence of fatty liver by ultrasound.
  
  
  RESULTS
  A significant decrease of Bright Liver Score (BLS) was observed only after 6 months of intervention: differently, at the first and third month of monitoring fatty liver changes were still not significant. By a multiple linear regression model Adherence to Mediterranean Diet change (p:0.015) and body mass index changes (p:<0.0001) independently explain the variance of decrease of fatty liver involvement (R2 = 0.519; p < 0.0001).
  
  
  CONCLUSIONS
  Adherence to Mediterranean Diet is a significant predictor of changes in the fat content of the liver in overweight patients with NAFLD. The effect of the diet is gradual and favorable and it is independent of other lifestyle changes.
authors: University of Catania, Department of Medical and Pediatric Sciences, Catania 95131, Italy.
authors: Francesca M
authors: FM
authors: Trovato
authors: University of Catania, Department of Medical and Pediatric Sciences, Catania 95131, Italy.
authors: Daniela
authors: D
authors: Catalano
authors: University of Catania, Department of Medical and Pediatric Sciences, Catania 95131, Italy.
authors: G Fabio
authors: GF
authors: Martines
authors: University of Catania, Department of Medical and Pediatric Sciences, Catania 95131, Italy.
authors: Patrizia
authors: P
authors: Pace
authors: University of Catania, Department of Medical and Pediatric Sciences, Catania 95131, Italy. Electronic address: guglielmotrovato@unict.it.
authors: Guglielmo M
authors: GM
authors: Trovato
mesh_terms: D000328:Adult; D015992:Body Mass Index; D038441:Diet, Mediterranean; D015444:Exercise; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000178:diet therapy* / Q000209:etiology; D009765:Obesity / Q000150:complications
keywords: Insulin resistance; Mediterranean diet; NAFLD; Obesity; Physical activity