Effect of a Low Glycemic Index Mediterranean Diet on Non-Alcoholic Fatty Liver Disease. A Randomized Controlled Clinici Trial
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INTRODUCTION: Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common form of liver disease worldwide affecting all ages and ethnic groups and it has become a consistent threat even in young people. Our aim was to estimate the effect of a Low Glycemic Index Mediterranean Diet (LGIMD) on the NAFLD score as measured by a Liver Ultrasonography (LUS). DESIGN: NUTRIzione in EPAtologia (NUTRIEPA) is a population-based Double-Blind RCT. Data were collected in 2011 and analyzed in 2013-14. SETTING/PARTICIPANTS: 98 men and women coming from Putignano (Puglia, Southern Italy) were drawn from a previous randomly sampled population-based study and identified as having moderate or severe NAFLD. INTERVENTION: The intervention strategy was the assignment of a LGIMD or a control diet. OUTCOME MEASURES: The main outcome measure was NAFLD score, defined by LUS. RESULTS: After randomization, 50 subjects were assigned to a LGIMD and 48 to a control diet. The study lasted six months and all participants were subject to monthly controls/checks. Adherence to the LGIMD as measured by Mediterranean Adequacy Index (MAI) showed a median of 10.1. A negative interaction between time and LGIMD on the NAFLD score (-4.14, 95% CI -6.78,-1.49) was observed, and became more evident at the sixth month (-4.43, 95%CI -7.15, -1.71). A positive effect of the interaction among LGIMD, time and age (Third month: 0.07, 95% CI 0.02, 0.12; Sixth month: 0.08, 95% CI 0.03,0.13) was also observed. CONCLUSIONS: LGIMD was found to decrease the NAFLD score in a relatively short time. Encouraging those subjects who do not seek medical attention but still have NAFLD to follow a LGIMD and other life-style interventions, may reduce the degree of severity of the disease. Dietary intervention of this kind, could also form the cornerstone of primary prevention of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease.
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Misciagna et al. reported a significant reduction in fatty liver index after 6 months of low-glycaemic Mediterranean diet intervention in patients with NAFLD compared to INRAN guidelines.
“Misciagna et al. [28], which assessed fatty liver by fatty liver index, reported a significant reduction in this index after 6 months low-glycaemic MD intervention in patients with NAFLD in comparison to INRAN guidelines.”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [28]
The Results (page unavailable) report that fatty liver index was significantly lower after six months, especially in the low-glycaemic Mediterranean diet group; the control diet followed INRAN guidelines. However, the paper describes a within-group test for fatty liver index and does not establish that its reduction was statistically significant compared with the control group. Its significant diet-by-time comparison concerns the ultrasound-measured NAFLD score, not fatty liver index. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAmong RCTs on the Mediterranean diet, three were low risk, seven had some concerns, and two were high risk of bias.
“Regarding the RCTs on the MD, three were defined as “Low Risk” [56, 60]; seven studies were defined as “Some concerns” [28, 55, 57, 59, 61, 62, 64]; and two studies were defined as “High-Risk” [58, 63].”
Randomized controlled crossover trials defined the superiority of the Mediterranean diet in the improvement of insulin sensitivity, metabolic parameters, and steatosis over low-fat diets.
“Cross-sectional and longitudinal reports evidenced a lower likelihood of NASH in patients who were adherent to the MedDiet [75,76], whereas randomized controlled crossover trials defined the superiority of this diet in the improvement of insulin sensitivity, metabolic parameters and steatosis over low-fat ones [77,78].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [78]
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- Authors
- Misciagna, G., del Pilar Díaz, M., Caramia, D. V., Bonfiglio, C., Franco, I., Noviello, M. R., Chiloiro, M., Abbrescia, D. I., Mirizzi, A., Tanzi, M., Caruso, M. G., Correale, M., Reddavide, R., Inguaggiato, R., Cisternino, A. M., & Osella, A. R.
- Affiliations
- Gastroenterology Hospital "Saverio de Bellis" (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- ORCID
- Venue
- The Journal of nutrition, health and aging
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 21
- Issue
- 4
- Pages
- 404-412
- ISSN
- 1279-7707 (ISSN-L)
- PMC
- PMC12879795
- OpenAlex
- W2525061232
- Cited by
- 134
- References
- 52
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 8 · 2023: 21 · 2022: 31 · 2021: 12 · 2020: 17 · 2019: 13 · 2018: 12 · 2017: 4
- FWCI
- 9.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The journal of nutrition health & aging (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- non-alcoholic fatty liver disease, low glycemic index diet, Mediterranean diet, liver ultrasound, NAFLD score, dietary adherence, lifestyle intervention, type 2 diabetes prevention, cardiovascular disease prevention, primary prevention, disease severity reduction
- MeSH terms
- Adult, Aged, Blood Glucose, Blood Pressure, Body Height, Body Weight, Diabetes Mellitus, Type 2, Double-Blind Method, Female, Humans, Insulin, Italy, Life Style, Male, Middle Aged, Surveys and Questionnaires, Glycemic Index, Diet, Mediterranean, Non-alcoholic Fatty Liver Disease
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