Association between Non-Alcoholic Fatty Liver Disease and Mediterranean Lifestyle: A Systematic Review.

Catalina M Mascaró,Josep A Tur,Cristina Bouzas

doi:10.3390/nu14010049

Abstract

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is an excessive accumulation of fat in the liver without alcohol abuse. It is linked to metabolic syndrome (MetS) and no pharmacological treatment exists. This systematic review aims to assess evidence about the effect of Mediterranean lifestyle on the prevention and reversion of NAFLD. Methods: A systematic literature search was performed in MEDLINE via Pubmed. MeSH terms used were: non-alcoholic fatty liver disease [MeSH Major Topic] AND metabolic syndrome [MeSH Term] AND (Diet, Mediterranean [MeSH Term]) OR (Exercise [MeSH Term]). (PROSPERO ID: 2021 CRD42021289495). Results: Thirteen articles were selected and divided into two categories (four focused on Mediterranean diet and NAFLD and nine focused on Mediterranean diet, physical activity, and NAFLD). Information of clinical endpoints was based on NAFLD, as well as MetS, body mass index, fasting glycemia, obesity, cholesterol, triglycerides, transaminases, albuminuria, and hepatic steatosis, among others. All studies found beneficial associations between the clinical parameters of NAFLD/MetS and following a Mediterranean diet and regular physical activity. Conclusions: An effective treatment that prevents, and even reverses, NAFLD is to adapt lifestyle to the Mediterranean one, based on a Mediterranean diet and regular physical activity.

Highlights

Non-alcoholic fatty liver disease (NAFLD) is defined as the accumulation of excessive fat in the liver not linked to alcohol abuse [1]
There has recently emerged the concept of metabolic dysfunction-associated fatty liver disease (MAFLD) [5], which is defined as the expression of NAFLD associated with a cluster of metabolic pathologies expressed at the same time
Most studies agreed that a Mediterranean diet and physical activity improved all or some of NAFLD risk factors: weight reduction [22,29,30], body mass index [24,29,30], waist circumference [24,29,30], triglyceridemia [22,29], LDLcholesterol [29,30,31], impaired fasting glycemia [22,29], visceral adipose index and fatty liver index [29], lipid accumulation [14,29], homeostatic model assessment-insulin resistance [29,30,31]; increased high-density lipoprotein (HDL)-cholesterol [22,29]; normalization of alanine aminotransferase [22,29,30]; reduction of gamma glutamyl transferase [30]; and improvement of steatosis [24,29,30,31]

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is defined as the accumulation of excessive fat in the liver not linked to alcohol abuse [1]. There has recently emerged the concept of metabolic dysfunction-associated fatty liver disease (MAFLD) [5], which is defined as the expression of NAFLD associated with a cluster of metabolic pathologies expressed at the same time. These pathologies may be hypertension, high levels of plasma triglyceride, and high-density lipoprotein (HDL)-cholesterol, as well as type 2 diabetes mellitus, obesity, and altered insulin resistance [6]. Conclusions: An effective treatment that prevents, and even reverses, NAFLD is to adapt lifestyle to the Mediterranean one, based on a Mediterranean diet and regular physical activity

Methods

Results

Discussion

Conclusion