title: The Mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease: Evidence and plausible mechanisms.
abstract: Non-alcoholic fatty liver disease (NAFLD) has become a major global health burden, leading to increased risk for cirrhosis, hepatocellular carcinoma, type-2 diabetes and cardiovascular disease. Lifestyle intervention aiming at weight reduction is the most established treatment. However, changing the dietary composition even without weight loss can also reduce steatosis and improve metabolic alterations as insulin resistance and lipid profile. The Mediterranean diet (MD) pattern has been proposed as appropriate for this goal, and was recommended as the diet of choice for the treatment of NAFLD by the EASL-EASD-EASO Clinical Practice Guidelines. The MD has an established superiority in long term weight reduction over low fat diet, but it improves metabolic status and steatosis even without it. However, the effect on liver inflammation and fibrosis was tested only in few observational studies with positive results. Furthermore, considering the strong association between NAFLD and diabetes and CVD, the MD has a highly established advantage in prevention of these diseases, demonstrated in randomized clinical trials. The individual components of the MD such as olive oil, fish, nuts, whole grains, fruits, and vegetables, have been shown to beneficially effect or negatively correlate with NAFLD, while consumption of components that characterize a Western dietary pattern as soft drinks, fructose, meat and saturated fatty acids have been shown to have detrimental association with NAFLD. In this review we will cover the epidemiological evidence and the plausible molecular mechanisms by which the MD as a whole and each of its components can be of benefit in NAFLD.
authors.affiliation: School of Public Health, University of Haifa, Haifa, Israel.|Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv, Israel.
authors.forename: Shira
authors.identifier: 0000-0002-1324-7497
authors.initials: S
authors.lastname: Zelber-Sagi
authors.affiliation: Division of Gastroenterology, Ospedale di Acireale, Azienda Sanitaria Provinciale di Catania, Catania, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Salomone
authors.affiliation: Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center, Tel-Aviv, Israel.|The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Mlynarsky
mesh_terms: D000818:Animals; D000072001:Diet, Healthy; D038441:Diet, Mediterranean; D066273:Diet, Western / Q000009:adverse effects; D006801:Humans; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
keywords: Mediterranean diet; fish oil; fruits; non-alcoholic fatty liver disease; olive oil; vegetables