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Mediterranean diet reduces liver fat, risk for NAFLD

Improved diet quality based on the Mediterranean-style diet score and Alternative Healthy Eating Index score correlated with less liver fat accumulation and a reduced risk for new-onset nonalcoholic fatty liver, according to a recently published study.

“Lifestyle modification, primarily a weight loss diet, is recommended for treatment of NAFLD. Available evidence also suggests that a healthy eating pattern such as a Mediterranean diet may favorably affect NAFLD independent of weight loss,” Jiantao Ma, PhD, from the Framingham Heart Study, Massachusetts, and colleagues wrote. “We demonstrate that improved diet quality over six years was associated with reduced liver fat accumulation and lower risk and severity of fatty liver in a group of middle-aged to older adults.”

Ma and colleagues enrolled participants of the Framingham Heart Study, excluding those with a history of excessive alcohol intake. The researchers provided a validated, self-administered food frequency questionnaire and calculated the participants’ Mediterranean-style diet score (MDS) and Alternative Healthy Eating Index score (AHEI).

Per one standard deviation increase in MDS, BMI decreased by 0.38 kg/m² (95% CI, 0.24-0.51), waist circumference decreased by 1.07 cm (95% CI, 0.69-1.45), and liver-phantom ratio decreased by 0.57 (95% CI, 0.27-0.86). Liver-phantom ratio decreased the most in the lowest quartile of MDS (–1.9; 95% CI, –2.63 to –1.18).

Similarly, per one standard-deviation score increase in AHEI, BMI declined by 0.38 kg/m² (95% CI, 0.25-0.51), waist circumference declined by 0.99 cm (95% CI, 0.64-1.35), and liver-phantom ratio decreased by 0.56 (95% CI, 0.29-0.84). Liver-phantom ratio also decreased the most in the lowest quartile of AHEI (–1.71; 95% CI, –2.41 to –1.01).

The odds for incident fatty liver decreased by 26% (95% CI, 10-39) per one standard deviation increase in MDS and by 21% (95% CI, 5-35) in AHEI.

Regarding food categories in the MDS, liver-phantom ratio increased per one standard deviation increase in scores for vegetables (0.31; 95% CI, 0-0.62), nuts (0.41; 95% CI, 0.09-0.74), legumes (0.38; 95% CI, 0.07-0.69) and lower red meat intake (0.35; 95% CI, 0.02-0.67), which reflected a longitudinal decline in liver fat.

Liver-phantom ratio also increased per one standard deviation increase in scores for vegetables (0.36; 95% CI, 0.06-0.67), fruits (0.5; 95% CI, 0.2-0.8), nuts and legumes (0.39; 95% CI, 0.09-0.69), whole grains (0.34; 95% CI, 0.02-0.66), eicosapentaenoic acid (0.37; 95% CI, 0.04-0.69), docosahexaenoic acid (0.31; 95% CI, 0.02-0.6), and lower red meat intake (0.41; 95% CI, 0.08-0.75).

“NALFD has reached epidemic-levels and has a substantial impact on public health,” the researchers wrote. “It is also projected to become the leading indication for liver transplantation in the U.S. by 2025, and when simple hepatic steatosis progresses to nonalcoholic steatohepatitis (NASH), individuals are at an increased risk for liver cancer. Our findings emphasize the notion that improving diet quality is an important strategy for NAFLD prevention and, particularly among those with high genetic risk.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.