Improvements in clinical characteristics of patients with non-alcoholic fatty liver disease, after an intervention based on the Mediterranean lifestyle: a randomised controlled clinical trial
Open accessAbstract
Lifestyle interventions remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD). This randomised controlled single-blind clinical trial investigated the effect of Mediterranean diet (MD) or Mediterranean lifestyle, along with weight loss, in NAFLD patients. In all, sixty-three overweight/obese patients (50 ( sd 11) years, BMI=31·8 ( sd 4·5) kg/m 2 , 68 % men) with ultrasonography-proven NAFLD (and elevated alanine aminotransferase (ALT) and/or γ-glutamyl transpeptidase (GGT) levels) were randomised to the following groups: (A) control group (CG), (B) Mediterranean diet group (MDG) or (C) Mediterranean lifestyle group (MLG). Participants of MDG and MLG attended seven 60-min group sessions for 6 months, aiming at weight loss and increasing adherence to MD. In the MLG, additional guidance for increasing physical activity and improving sleep habits were given. Patients in CG received only written information for a healthy lifestyle. At the end of 6 months, 88·8 % of participants completed the study. On the basis of intention-to-treat analysis, both MDG and MLG showed greater weight reduction and higher adherence to MD compared with the CG (all P <0·05) at the end of intervention. In addition, MLG increased vigorous exercise compared with the other two study groups ( P <0·001) and mid-day rest/naps compared with CG ( P =0·04). MLG showed significant improvements in ALT levels (i.e. ALT<40 U/l ( P =0·03) and 50 % reduction of ALT levels ( P =0·009)) and liver stiffness ( P =0·004) compared with CG after adjusting for % weight loss and baseline values. MDG improved only liver stiffness compared with CG ( P <0·001) after adjusting for the aforementioned variables. Small changes towards the Mediterranean lifestyle, along with weight loss, can be a treatment option for patients with NAFLD.
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Four RCTs showed improvements in fibrosis outcomes with the Mediterranean diet compared to standard care, Research Center for Food and Nutrition diet, and low-fat diet.
“Regarding liver fibrosis, four RCTs showed improvements in fibrosis outcomes with the MD compared to standard care [59, 61], Research Center for Food and Nutrition diet [58], and low-fat diet [55].”
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- Authors
- Katsagoni, C. N., Papatheodoridis, G. V., Ioannidou, P., Deutsch, M., Alexopoulou, A., Papadopoulos, N., Papageorgiou, M.-V., Fragopoulou, E., & Kontogianni, M. D.
- Affiliations
- Harokopio University of Athens (GR)
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Kontogianni, Meropi D.
- ORCID
- Venue
- British Journal of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-06-27
- Volume
- 120
- Issue
- 2
- Pages
- 164-175
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- OpenAlex
- W2810964789
- Cited by
- 167
- References
- 9
- Citations by year
- 2026: 12 · 2025: 33 · 2024: 20 · 2023: 25 · 2022: 26 · 2021: 24 · 2020: 17 · 2019: 9 · 2018: 1
- FWCI
- 10.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- State Scholarships Foundation
- Harokopio University
- 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 › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, Mediterranean diet, Mediterranean lifestyle, lifestyle intervention, weight loss, physical activity, sleep habits, napping, alanine aminotransferase, liver stiffness, dietary adherence, overweight and obesity
- MeSH terms
- Adolescent, Adult, Aged, Alanine Transaminase, Anthropometry, Body Weight, Female, Fibrosis, gamma-Glutamyltransferase, Humans, Life Style, Liver, Male, Middle Aged, Obesity, Outpatients, Patient Compliance, Sleep, Weight Loss, Exercise, Single-Blind Method, Diet, Mediterranean, Overweight, Elasticity Imaging Techniques, Young Adult, Non-alcoholic Fatty Liver Disease
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