Effects of Mediterranean Diet in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Randomized Controlled Trials

Takumi Kawaguchi; Michael Charlton; Atsushi Kawaguchi; Sakura Yamamura; Dan Nakano; Tsubasa Tsutsumi; Maryam Zafer; Takuji Torimura

doi:10.1055/s-0041-1723751

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2021; 41(03): 225-234
DOI: 10.1055/s-0041-1723751

Review Article

Effects of Mediterranean Diet in Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Randomized Controlled Trials

Takumi Kawaguchi

¹Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan

,

Michael Charlton

²Department of Medicine, Center for Liver Diseases, University of Chicago Medicine, Chicago, Illinois

,

Atsushi Kawaguchi

³Section of Clinical Cooperation System, Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan

,

Sakura Yamamura

¹Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan

,

Dan Nakano

¹Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan

,

Tsubasa Tsutsumi

¹Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan

,

Maryam Zafer

²Department of Medicine, Center for Liver Diseases, University of Chicago Medicine, Chicago, Illinois

,

Takuji Torimura

¹Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan

› Author Affiliations

Abstract

We conducted a meta-analysis to investigate the effects of the Mediterranean Diet (Med-Diet) on hepatic steatosis and insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD). Six randomized controlled trials were selected for the meta-analysis (sample size: 250 participants). In the meta-analysis, there was no significant difference in body mass index and waist circumference between the Med-Diet and control groups. Med-Diet significantly reduced fatty liver index (FLI) compared with the control diet (standard mean difference [SMD]: –1.06; 95% CI: –1.95 to –0.17; p = 0.02). Med-Diet significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) compared with the control diet (SMD: –0.34; 95% CI: –0.65 to –0.03; p = 0.03). Similarly, a meta-regression analysis using age showed that Med-Diet significantly reduced FLI and HOMA-IR (95% CI: –0.956 to –0.237, p = 0.001 and 95% CI: –0.713 to –0.003, p = 0.048, respectively). This meta-analysis demonstrated that Med-Diet improved hepatic steatosis and insulin resistance in patients with NAFLD. Thus, Med-Diet is a beneficial pharmaconutritional therapy in patients with NAFLD.

Keywords

Mediterranean diet - nonalcoholic fatty liver disease - metabolism - lipid metabolism - insulin resistance - liver stiffness

Full Text

References

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Supplementary Material

Supplementary Material