Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease

doi:10.3748/wjg.v23.i17.3150

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Observational Study

World J Gastroenterol. May 7, 2017; 23(17): 3150-3162
Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3150

Table 1 Main characteristics of 46 patients recruited for the study

Parameter	Value (mean ± SD or frequency)
Population n (%)
Total	46
M	29 (63%)
F	17 (37%)
Age (yr)
Range	26-71
mean ± SD	47.5 ± 12
BMI (kg/m²)
Range	18.9-45.3
mean ± SD	29.3 ± 6.1
BMI (kg/m²)
Obesity grade
18.5-24.9 (normal weight)	23.90%
25-29.9 (overweight)	43.50%
30-34.9 (class I obesity)	17.40%
35-39.9 (class II obesity)	8.70%
≥ 40 (class III obesity)	6.50%
Waist circumference (cm)
M	100.88 ± 12.97
F	101.88 ± 15.07
Obesity central (Waist circumference)
M (> 10² cm)	48.30%
F (> 88 cm)	82.40%
Waist-to-hip ratio
Android obesity
M (≥ 1)	41.40%
F (≥ 0.85)	70.60%
Gynoid obesity
M (≤ 0.94)	20.70%
F (≤ 0.78)	0.00%
Components of MS²
0	4 (8.7%)
1	20 (43.5%)
2	10 (21.7%)
3	5 (10.9%)
4	5 (10.9%)
5	2 (4.3%)
Liver steatosis grade
1	3 (6.5%)
2	19 (41.3%)
3	24 (52.2%)
MedDiet Score
Range	21-41
mean ± SD	28.4 ± 3.9
Physical activity
No	24 (52.2%)
Yes	22 (47.8%)
Times¹/wk
1	6 (13%)
2	7 (15.2%)
3	7 (15.2%)
> 3	2 (4.3%)
Smoking
No	35 (76.1%)
Ex	3 (6.5%)
Yes	8 (17.4%)

¹At least 30 min of moderate/intense activity;

²According to Alberti et al[39].

Table 2 Frequency of metabolic syndrome’ components in patients with metabolic syndrome

Component	Hypertension	Blood pressure	TG	HDL	Serum glucose
n	12	6	12	7	8

TG: Triglycerides; HDL: High-density lipoprotein.

Table 3 Anthropometric, clinical and metabolic parameters at baseline, mid-intervention (3M) and end-intervention (6M) and results of the statistical analysis

Parameter	mean ± SD, BL	mean ± SD, 3M	mean ± SD, 6M	P value
Parameter	mean ± SD, BL	mean ± SD, 3M	mean ± SD, 6M	BL vs 3M	3M vs 6M	BL vs 6M
BMI (kg/m²)	29.3 ± 6.11	28.0 ± 6.21	27.5 ± 6.21	< 0.01^a	< 0.01^a	< 0.01^a
Waist circumference (cm)	101.25 ± 13.63	97.50 ± 14.07	96.24 ± 13.64	< 0.01^a	< 0.01^a	< 0.01^a
Hip-to-waist ratio	0.95 ± 0.08	0.94 ± 0.07	0.93 ± 0.08	< 0.01^a	< 0.01^a	< 0.01^a
AST (U/L)	36.16 ± 21.11	28.73 ± 11.28	24.84 ± 10.70	< 0.01^a	< 0.01^a	< 0.01^a
ALT (U/L)	65.66 ± 31.92	48.37 ± 33.44	37.33 ± 19.53	< 0.01^a	< 0.01^a	< 0.01^a
GGT (U/L)	60.19 ± 61.43	41.35 ± 36.49	39.73 ± 35.36	< 0.01^a	0.545	< 0.01^a
FA (U/L)	81.48 ± 37.19	79.54 ± 32.04	80.04 ± 35.02	0.489	0.787	0.574
Total cholesterol (mg/dL)	215.24 ± 40.78	205.04 ± 41.75	207.18 ± 38.48	0.044^a	0.598	0.097
LDL cholesterol (mg/dL)	137.70 ± 32.87	131.25 ± 35.88	130.16 ± 32.65	0.071	0.941	0.050^a
HDL cholesterol (mg/dL)	49.72 ± 10.59	50.17 ± 11.64	53.09 ± 11.86	0.550	< 0.01^a	< 0.01^a
TG (mg/dL)	133.39 ± 67.77	123.65 ± 71.31	118.24 ± 65.14	0.112	0.358	0.017^a
Serum glucose (mg/dL)	98.33 ± 15.87	94.52 ± 13.07	95.76 ± 13.46	< 0.01^a	0.133	< 0.01^a
Chol Tot/HDL	4.50 ± 1.27	4.23 ± 1.07	3.95 ± 1.15	0.013^a	0.010^a	< 0.01^a
LDL/HDL	2.89 ± 0.95	2.67 ± 0.93	2.56 ± 0.84	0.028^a	0.015^a	< 0.01^a
TG/HDL	2.87 ± 1.76	2.66 ± 1.89	2.39 ± 1.66	0.152	0.037^a	< 0.01^a
AIP	0.03 ± 0.25	-0.01 ± 0.23	-0.06 ± 0.25	0.097	0.089	< 0.01^a
HOMA- IR (mU/L)	3.25 ± 1.96	2.96 ± 1.73	2.94 ± 1.67	< 0.01^a	0.841	< 0.01^a
QUICKI	0.33 ± 0.04	0.34 ± 0.04	0.34 ± 0.03	< 0.01^a	0.330	< 0.017^a
PLR	115.37 ± 46.60	109.89 ± 51.77	113.65 ± 43.77	0.195	0.281	0.816
NLR	1.98 ± 1.12	1.88 ± 1.10	1.79 ± 0.89	0.287	0.509	0.185
FLI	61.55 ± 26.76	50.54 ± 29.37	48.83 ± 31.01	< 0.01^a	0.286	< 0.01^a
Kotronen index (%)	6.05 ± 5.02	4.10 ± 2.22	3.92 ± 2.40	< 0.01^a	0.277	< 0.01^a
VAI	1.85 ± 1.17	1.55 ± 0.71	1.32 ± 0.65	0.011	0.010	< 0.01^a
NAFLD Liver Fat Score	0.12 ± 1.63	-0.02 ± 1.42	-0.70 ± 1.20	0.418	< 0.01^a	< 0.01^a
LAP (male)	48.41 ± 28.14	37.01 ± 19.95	33.18 ± 17.49	< 0.01^a	0.166	< 0.01^a
LAP (female)	84.15 ± 63.06	78.92 ± 70.51	74.13 ± 58.89	0.290	0.452	< 0.01^a
BARD	1.09 ± 1.26	1.46 ± 1.17	1.37 ± 1.04	0.011^a	0.486	0.091
NAFLD	-2.29 ± 0.93	-2.13 ± 1.01	-2.28 ± 1.00	0.015^a	0.032^a	0.986

Values are expressed as mean ± SD.

^aP ≤ 0.05, significant difference. BL: Baseline; NAFLD: Non-alcoholic fatty liver disease; TG: Triglycerides; HDL: High-density lipoprotein; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase.

Table 4 Correlation between steatosis grade and anthropometric, clinical and metabolic parameters considered in this study at baseline and at end-treatment

Parameter		Grade 0 (n = 9)	Grade I (n = 15)	Grade 2 (n = 18)	Grade 3 (n = 4)	P value
Parameter		mean ± STD	mean ± STD	mean ± STD	mean ± STD	P value
BMI (kg/m²)	BL	-	30.19 ± 2.15	28.05 ± 6.47	30.11 ± 6.14	0.499
BMI (kg/m²)	6M	23.39 ± 3.52	25.94 ± 5.60	31.36 ± 6.53	25.77 ± 1.14	0.013^a
Waist circumference (cm)	BL	-	103.00 ± 1.73	96.05 ± 12.94	105.15 ± 13.91	0.122
Waist circumference (cm)	6M	86.44 ± 11.98	90.73 ± 9.24	106.03 ± 12.64	94.88 ± 9.37	< 0.01^a
Hip-to-waist ratio (-)	BL	-	0.94 ± 0.05	0.91 ± 0.08	0.98 ± 0.07	0.020^a
Hip-to-waist ratio (-)	6M	0.88 ± 0.06	0.91 ± 0.06	0.97 ± 0.08	0.93 ± 0.09	< 0.01^a
Tot Chol (mg/dL)	BL	-	260.67 ± 27.21	210.95 ± 31.20	212.96 ± 46.24	0.266
Tot Chol (mg/dL)	6M	215.89 ± 39.78	196.27 ± 62.92	212.06 ± 34.35	154.75 ± 44.90	0.078
HDL (mg/dL)	BL	-	47.00 ± 3.46	52.05 ± 13.39	48.21 ± 8.39	0.532
HDL (mg/dL)	6M	142.16 ± 33.53	130.60 ± 22.94	131.33 ± 35.27	96.25 ± 38.88	0.070
LDL (mg/dL)	BL	-	186.67 ± 37.63	133.52 ± 19.00	134.88 ± 37.05	0.119
LDL (mg/dL)	6M	54.33 ± 12.97	53.73 ± 14.08	53.56 ± 10.74	45.75 ± 1.89	0.399
TG (mg/dL)	BL	-	134.00 ± 43.28	125.21 ± 42.18	139.79 ± 85.63	0.597
TG (mg/dL)	6M	100.22 ± 31.69	119.20 ± 40.40	138.22 ± 88.51	65.25 ± 42.94	0.807
AST	BL	-	0.72 ± 0.28	0.87 ± 0.33	0.95 ± 0.67	0.435
AST	6M	0.55 ± 0.15	0.63 ± 0.19	0.67 ± 0.37	0.53 ± 0.17	0.641
ALT	BL	-	0.91 ± 0.20	1.32 ± 0.68	1.35 ± 0.64	0.419
ALT	6M	0.56 ± 0.14	0.79 ± 0.37	0.82 ± 0.50	0.67 ± 0.23	0.334
AST/ALT	BL	-	0.76 ± 0.15	0.71 ± 0.19	0.66 ± 0.20	0.276
AST/ALT	6M	0.95 ± 0.15	0.76 ± 0.22	0.73 ± 0.26	0.78 ± 0.11	0.058
GGT	BL	-	58.67 ± 64.53	51.89 ± 54.69	42.21 ± 25.60	0.392
GGT	6M	17.00 ± 4.12	43.53 ± 25.67	44.39 ± 0.10	27.25 ± 0.50	0.147
Blood gluc. (mg/dL)	BL	-	96.67 ± 9.29	94.16 ± 15.71	101.83 ± 16.26	0.181
Blood gluc. (mg/dL)	6M	88.00 ± 1.94	91.27 ± 7.33	104.33 ± 17.03	91.50 ± 8.19	0.018^a
SM (n)	BL	-	2.67 ± 1.15	1.32 ± 1.00	2.17 ± 1.43	0.350
SM (n)	6M	1.44 ± 1.13	1.73 ± 1.28	2.28 ± 1.49	1.25 ± 0.50	0.415
Tot-Chol/HDL	BL	-	5.60 ± 1.03	4.29 ± 1.27	4.53 ± 1.26	0.637
Tot-Chol/HDL	6M	4.07 ± 0.84	3.84 ± 1.55	4.09 ± 0.94	3.41 ± 1.09	0.479
LDL/HDL	BL	-	4.03 ± 1.14	2.72 ± 0.82	2.88 ± 0.96	0.355
LDL/HDL	6M	2.70 ± 0.82	2.60 ± 0.90	2.54 ± 0.82	2.12 ± 0.91	0.333
TG/HDL	BL	-	2.83 ± 0.78	2.63 ± 1.36	3.07 ± 2.11	0.516
TG/HDL	6M	1.92 ± 0.73	2.44 ± 1.25	2.79 ± 2.24	1.46 ± 1.02	0.698
AIP	BL	-	0.44 ± 0.11	0.37 ± 0.21	0.39 ± 0.29	0.983
AIP	6M	0.25 ± 0.19	0.34 ± 0.21	0.35 ± 0.27	0.08 ± 0.31	0.780
HOMA-IR (mU/L)	BL	-	2.77 ± 0.22	2.37 ± 1.37	4.01 ± 2.18	0.015^a
HOMA-IR (mU/L)	6M	1.50 ± 0.84	2.47 ± 1.06	4.12 ± 1.71	2.67 ± 1.51	< 0.01^a
QUICKI	BL	-	0.33 ± 0.00	0.35 ± 0.04	0.32 ± 0.03	0.082
QUICKI	6M	0.37 ± 0.05	0.34 ± 0.02	0.32 ± 0.02	0.34 ± 0.03	< 0.01^a
PLR	BL	-	120.89 ± 28.83	107.31 ± 32.51	121.06 ± 57.08	0.467
PLR	6M	93.44 ± 22.18	106.95 ± 48.08	127.33 ± 47.95	122.70 ± 30.46	0.058
NLR	BL	-	1.36 ± 0.37	1.79 ± 0.80	2.21 ± 1.34	0.112
NLR	6M	1.32 ± 0.21	1.67 ± 1.08	2.21 ± 0.85	1.44 ± 0.50	0.097
FLI	BL	-	98.97 ± 0.30	98.84 ± 0.39	98.70 ± 0.75	0.612
FLI	6M	98.48 ± 0.72	98.79 ± 0.40	98.75 ± 0.67	97.08 ± 1.82	0.143
Kotronen index (%)	BL	-	4.63 ± 2.14	4.3 ± 2.0	7.6 ± 6.4	0.047^a
Kotronen index (%)	6M	2.15 ± 0.83	3.5 ± 1.0	5.3 ± 3.2	3.1 ± 0.6	0.017^a
VAI	BL	-	3.5 ± 1.8	1.9 ± 1.0	1.6 ± 1.1	0.041^a
VAI	6M	1.44 ± 0.64	1.38 ± 0.65	1.29 ± 0.67	0.9 ± 0.67	0.224
NAFLD fat liver score	BL	-	-0.42 ± 0.9	-0.6 ± 1.1	0.7 ± 1.8	0.016^a
NAFLD fat liver score	6M	1.88 ± 0.71	-0.84 ± 0.78	0.07 ± 1.27	-0.99 ± 0.63	< 0.01^a
LAP (male)	BL	-	52.00 ± 0.00	44.27 ± 19.98	50.51 ± 32.82	0.694
LAP (male)	6M	25.67 ± 11.38	31.11 ± 14.62	42.38 ± 19.13	26.11 ± 22.32	0.386
LAP (female)	BL	-	72.10 ± 32.56	56.13 ± 31.50	130.21 ± 83.11	0.377
LAP (female)	6M	24.42 ± 16.25	52.21 ± 23.70	109.22 ± 67.63	-	0.147
BARD	BL	-	2.33 ± 1.15	0.79 ± 1.08	1.17 ± 1.34	0.733
BARD	6M	1.89 ± 0.33	1.07 ± 1.03	1.56 ± 1.15	0.50 ± 1.00	0.192
NAFLD	BL	-	-3.41 ± 0.48	-2.25 ± 0.73	-2.17 ± 1,02	0.112
NAFLD	6M	-2.44 ± 0.93	-2.68 ± 0.87	-1.88 ± 1.07	-2.27 ± 0.91	0.144
MedDiet Score	BL	-	30.0 ± 3.0	29.6 ± 4.6	27.2 ± 3.1	0.044^a
MedDiet Score	6M	NA	NA	NA	NA	NA

^aP ≤ 0.05, significant difference. NAFLD: Non-alcoholic fatty liver disease; TG: Triglycerides; HDL: High-density lipoprotein; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase.

Table 5 Correlation between BMI and anthropometric, clinical and metabolic parameters considered in this study at baseline and at end-treatment

Parameter		P value	Parameter		P value
Steatosis grade	BL	0.499	TG/HDL	BL	0.370
Steatosis grade	6M	0.013^a	TG/HDL	6M	0.416
Waist circumf. (cm)	BL	< 0.01^a	AIP	BL	0.194
Waist circumf. (cm)	6M	< 0.01^a	AIP	6M	0.307
Hip-to-waist ratio (-)	BL	0.231	HOMA-IR (mU/L)	BL	< 0.01^a
Hip-to-waist ratio (-)	6M	0.020^a	HOMA-IR (mU/L)	6M	< 0.01^a
Tot Chol (mg/dL)	BL	0.257	QUICKI	BL	< 0.01^a
Tot Chol (mg/dL)	6M	< 0.01^a	QUICKI	6M	< 0.01^a
HDL (mg/dL)	BL	0.255	PLR	BL	0.213
HDL (mg/dL)	6M	< 0.01^a	PLR	6M	0.645
LDL (mg/dL)	BL	0.211	NLR	BL	0.066
LDL (mg/dL)	6M	0.768	NLR	6M	0.167
TG (mg/dL)	BL	0.352	FLI	BL	< 0.01^a
TG (mg/dL)	6M	0.229	FLI	6M	0.137
AST	BL	0.244	Kotronen index (%)	BL	0.038^a
AST	6M	0.093	Kotronen index (%)	6M	< 0.01^a
ALT	BL	0.504	VAI	BL	0.479
ALT	6M	0.154	VAI	6M	0.373
AST/ALT	BL	0.195	NAFLD fat liver score	BL	< 0.01^a
AST/ALT	6M	0.114	NAFLD fat liver score	6M	< 0.01^a
GGT	BL	0.075	LAP (male)	BL	< 0.01^a
GGT	6M	0.176	LAP (male)	6M	< 0.01^a
MS (n)	BL	0.025^a	LAP (female)	BL	0.075
MS (n)	6M	0.025^a	LAP (female)	6M	0.176
Blood gluc. (mg/dL)	BL	0.182	BARD	BL	< 0.01^a
Blood gluc. (mg/dL)	6M	0.142	BARD	6M	0.079
Tot-Chol/HDL	BL	0.218	NAFLD	BL	0.058
Tot-Chol/HDL	6M	0.090	NAFLD	6M	0.167
LDL/HDL	BL	0.185	MedDiet Score	BL	0.049^a
LDL/HDL	6M	0.087	MedDiet Score	6M	NA

^aP ≤ 0.05, significant difference. TG: Triglycerides; HDL: High-density lipoprotein.

Citation: Gelli C, Tarocchi M, Abenavoli L, Di Renzo L, Galli A, De Lorenzo A. Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease. World J Gastroenterol 2017; 23(17): 3150-3162
URL: https://www.wjgnet.com/1007-9327/full/v23/i17/3150.htm
DOI: https://dx.doi.org/10.3748/wjg.v23.i17.3150