Alimentary regimen in non-alcoholic fatty liver disease: Mediterranean diet

Table 1 Main studies on Mediterranean diet in the treatment of non-alcoholic fatty liver disease

Ref.	Patients	Nutritional protocol	Metabolic and histological changes
Shai et al[70]	322 obese patients (277 males)	Low-fat diet MD Low-carbohydrate diet	Weight loss (kg): 2.9 low-fat diet, 4.4 MD, 5.5 low-carbohydrate diet
			TC/HDL reduction (20%) in the low-carbohydrate diet;
			decrease in fasting plasma glucose levels and HOMA-IR in MD
			Changes in adiponectin, leptin, ALP, ALT similar in all diet group
Tzima et al[71]	1514 males 1528 females	MD	Higher MD score was associated with lower likelihood of having the metabolic syndrome
			In patients without or with moderate adherence to the MD an increase in the AST/ALT ratio was associated with lower likelihood of having the metabolic syndrome
			In patients with greater adherence to the MD AST/ALT ratio was not associated with the presence of the metabolic syndrome
Pérez-Guisado et al[72]	31 obese patients (22 males)	Spanish ketogenic MD	Improvement in body weight
			Steatosis degree
			Reduction in BMI, systolic blood pressure and diastolic blood pressure, total cholesterol, triacylglycerols, glucose and LDLc
			Increase in HDLc
Ryan et al[74]	12 non-diabetic patients (6 males) with NAFLD	MD control diet (low fat-high carbohydrate diet)	Weight loss with both diets
			Significant reduction in hepatic steatosis with MD
			Insulin sensitivity improved with MD
Kontogianni et al[75]	73 overweight NAFLD patients (50 males)	MD	MD score was negatively correlated to serum alanine aminotransferase, insulin levels, insulin resistance index and severity of steatosis
			MD score was positively correlated to serum adiponectin levels
Trovato et al[76]	90 non-alcoholic non-diabetic patients (44 males)	MD	Significant decrease of bright liver score (BLS)
			Adherence to MD change and body mass index changes (multiple linear regression model) independently explain the variance of decrease of fatty liver involvement

NAFLD: Non-alcoholic fatty liver disease; MD: Mediterranean diet; TC: Total-cholesterol; HOMA-IR: Homeostasis model assessment for insulin resistance; ALP: Alkaline phosphatase; AST: Aspartate aminio-transferase; ALT: Alanine amino-transferase; LDLc: Low density lipoprotein-cholesterol; HDLc: High density lipoprotein-cholesterol; BMI: Body mass index.