Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease

Table 1 Association between the Mediterranean dietary patterns and nonalcoholic fatty liver disease

Ref.	Country/Region	Assess adherence to the MD	Food groups associated with lower risk NAFLD	Study design	Number of patients and age range	Main results	Associations
Entezari et al[40]	Iran	MDS	↑ Intake nuts and fruits, vegetables, legumes, high MUFA/PUFA ratio, cereals and fish. ↓ EI, low-fat dairy and meats	C-C	247 (43.7% male); 18–55 yr	↑ Adherence to MD was associated with ↓ risk of NAFLD after controlling for age (OR: 0.40, 95%CI: 0.17–0.95) and sex, diabetes, PA and supplement intake (OR: 0.36, 95%CI: 0.15–0.89). This association disappeared after adjusting for BMI, WHR (OR: 0.70, 95%CI: 0.25–1.97)	↓, After controlling for anthropometrical variables ↔
Giraldi et al[41]	Italy	MDS	↑ Legumes consumption ↓ risk of NAFLD (OR: 0.62; 95%CI: 0.38-0.99) and ↑ fish intake ↓ risk of NAFLD (OR: 0.38; 95%CI: 0.17-0.85)	C-C	815 (371 with NAFLD); 59 ± 16 yr; 444 controls; 45 ± 14 yr	↑ Adherence to the MD was associated with ↓ risk of NAFLD (OR: 0.83; 95%CI: 0.71-0.98) after controlling for age, sex, EI, diabetes status, smoking status, BMI and PA	↓
Baratta et al[42]	Italy	MD questionnaire	↓ Meat intake	C-S	584 patients (61.8% males) with cardiometabolic risk factors screened for the presence of liver steatosis; 56.2 ± 12.4 yr	↑ Adherence to MD was associated with ↓ risk of NAFLD (intermediate vs low tertile OR: 0.12; P < 0.05; high vs low tertile OR: 0.09; P < 0.05)	↓
Aller[45]	Spain	14-item MD assessment tool	-	C-S	82 NAFLD patients (42.7% low and 57.3% high steatosis grade, 68.3% steatohepatitis and 51.2% liver fibrosis mean age 44 + 11 yr	↑ Adherence to MD was associated with ↓ likelihood of having steatohepatitis OR: 0.43; 95%CI: 0.29-0.64 and steatosis OR: 0.42; 95%CI: 0.26- 0.70	↓
Park et al[46]	United States; 5 targeted racial/ethnic groups: African American, Native Hawaiian, Japanese American, Latino and White	Alternate MDS	-	Nested C-C	2959 with NAFLD (509 with cirrhosis; 2450 without cirrhosis) and 29292 controls; mean age 44.2 + 11.3 yr	↑ Adherence to MD was not associated with lower NAFLD risk	↔
Chan et al[47]	Hong Kong of China	MDS	↑ Vegetables and legumes, fruits and dried fruits, vitamin C	C-S	797 (41.7% males) 27.6% had a fatty liver aged ≥ 18 yr	MDS was not associated with the prevalence of NAFLD	↔
Kontogianni et al[44]	Greece	MDS	-	C-S	73 overweight/obese patients with NAFLD (69% males) vs 58 age-sex- and BMI matched controls; mean age 45 yr	No difference in the MDS was observed between patients and controls. One unit increase in the MDS was associated with ↓ likelihood of having NASH (OR: 0.64; 95%CI: 0.45-0.92), after controlling for sex and abdominal fat	↓

BMI: Body mass index; C-C: Case-control; C-S: Cross-sectional; CI: Confidence interval; EI: Energy intake; MD: Mediterranean diet; MDS: Mediterranean Diet Score; MUFA/PUFA: Monounsaturated fatty acids/Polyunsaturated fatty acids; NAFLD: Non-alcoholic fatty liver disease; OR: Odds ratio; WHR: Waist to hip ratio; PA: Physical activity.