Investigation about the correlation between the severity of metabolic-associated fatty liver disease and adherence to the Mediterranean diet

Abstract

Metabolic-associated fatty liver disease (MAFLD) is defined by fatty liver combined with a disturbed metabolic state. Mediterranean diet (MedDiet) contains anti-inflammatory, anti-oxidative, and anti-fibrotic components and is seemingly beneficial in the management of MAFLD. We aimed to evaluate the correlation between adherence to MedDiet and the severity of MAFLD. Totally 101 adult patients diagnosed with MAFLD were enrolled in this cross-sectional study. Persian version of Mediterranean Diet Adherence Screener (MEDAS), demographics, clinical, laboratory, and FibroScan findings were collected. Correlation and regression analyses were performed. The mean of participants' age was 49.37±12.14 (51.48% male subjects). Six patients (5 diabetic and 1 pre-diabetic) had advanced fibrosis. Overall, 48.5% had good adherence to MedDiet [the least MEDAS-1 (15.8%) and the highest MEDAS-13 (99%)]. The adherence score was significantly higher in married, female, non-smoker, and diabetic subjects, and patients with hypertension. Adherence to MedDiet had insignificant correlations with hepatic fibrosis (P=0.888), steatosis (P=0.208), waist-to-height ratio (P=0.853), and FIB-4 score (P=0.919). Vitamin D level had just significant inverse associations with steatosis score (r=-0.21, P=0.037) and no significant association was found with fibrosis score (r=-0.036, P=0.717) and MedDiet adherence (r=0.055, P=0.581). According to the multiple regression analyses, less fruit intake, lower platelet count and DM had significant positive correlations with MAFLD severity (P<0.001). Adherence to Mediterranean diet, particularly a higher fruit intake, is associated with a lower severity of MAFLD. Dietary modification based on taste, economic state, and culture should be deliberated in different geographic areas along with nutritional education.