Calorie-Restricted Mediterranean and Low-Fat Diets Affect Fatty Acid Status in Individuals with Nonalcoholic Fatty Liver Disease
Open accessAbstract
Lifestyle modifications are the main support of nonalcoholic fatty liver disease (NAFLD) therapy. Weight loss is one of the primary goals in NAFLD, but the effects of different calorie-restricted diets remain unclear. Thus, we evaluated the effects of two calorie-restricted diets—the Mediterranean diet (Med diet) and low-fat diet—on liver status, cardiometabolic markers, and fatty acid profiles in patients with NAFLD. Twenty-four overweight/moderately obese men were randomly assigned to consume one of these diets. Lipid levels, glucose, insulin, liver enzymes, steatosis, and fatty acid profiles of serum and erythrocytes phospholipids were assessed. After 3 months, all participants had a significant weight loss (>9%), with improvements in waist circumference, body fat %, index of visceral adiposity (VAI), lipid accumulation product, fatty liver (FLI), and hepatic steatosis (HSI) index (p < 0.001). Both diets significantly lowered triglycerides, total and LDL-cholesterol, liver enzymes, fasting glucose, insulin, and HOMA-IR index. Fatty acid profiles were enhanced after both diets, with a significantly decreased n-6/n-3 ratio. Participants on the Med diet had higher levels of HDL-cholesterol and monounsaturated and n-3 docosahexaenoic acids in serum phospholipids and lower levels of saturated fatty acids, triglycerides, TG/HDL ratio, and FLI when compared to participants on the low-fat diet. Our results indicate that dietary patterns and calorie restriction represent central therapeutic issues in the improvement of obesity-related cardiometabolic alterations that are involved in the mechanism of hepatic steatosis. The Med diet may contribute to disease treatment even more than the low-fat diet since it leads to decreased saturated and increased monounsaturated and n-3 polyunsaturated fatty acid status and improved FLI in NAFLD patients.
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In patients with MASLD/MASH, the Mediterranean diet significantly reduced BMI compared with standard care or control diet (WMD = -0.70 kg/m2, 95% CI -1.03 to -0.36, P < 0.001).
“In total, seven studies reported data revealed that the MD significantly reduced BMI [56–60, 62, 64](WMD = − 0.70 kg/m2, 95% CI = − 1.03 to − 0.36, P < 0.001)”
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 [62]
The Results report that BMI improved significantly from baseline after 12 weeks in both the Mediterranean- and low-fat-diet groups. This paper is relevant as a study contributing BMI data, but it does not report a significant between-diet BMI difference or the seven-study pooled WMD and confidence interval quoted in the citing sentence. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn patients with MASLD/MASH, the Mediterranean diet did not significantly affect AST levels (WMD = -2.14 IU/L, 95% CI -5.63 to 1.34, P = 0.23).
“the effect sizes obtained from four RCTs [59, 60, 62, 63] did not show any significant effect of the MD on AST levels (WMD = − 2.14 IU/L, 95% CI = − 5.63 to 1.34, P = 0.23).”
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 [62]
The Methods (§2.1–2.2; page unavailable) describe a randomized Mediterranean-versus-low-fat diet trial, and the Results (§3; page unavailable) report AST outcomes, so this is the kind of trial the citing sentence identifies. But this paper does not report the four-trial pooled WMD, confidence interval, or P value; its own Results say AST fell significantly after both diets. An individual trial’s finding does not establish or refute the stated pooled result. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn patients with MASLD/MASH, the Mediterranean diet significantly reduced waist circumference compared with standard care or control diet (WMD = -1.56 cm, 95% CI -3.02 to -0.09, P = 0.04).
“and WC [56–60, 62, 64] (WMD = − 1.56 cm, 95% CI = − 3.02 to − 0.09, P = 0.04) in comparison to standard care or control diet”
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 [62]
The Results (page unavailable) report that waist circumference improved significantly from baseline after 12 weeks on either the Mediterranean or low-fat diet. The paper does not report a significant Mediterranean-diet advantage for waist circumference over the low-fat diet, nor the cited pooled estimate of −1.56 cm (95% CI −3.02 to −0.09). (LLM, conf=0.87)
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- Authors
- Ristic-Medic, D., Kovacic, M., Takic, M., Arsic, A., Petrovic, S., Paunovic, M., Jovicic, M., & Vucic, V.
- Affiliations
- Group for Nutritional Biochemistry and Dietology, Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia
- Group for Immunology, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia
- Group for Nutrition and Metabolism, Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia
- University Hospital Center Dr Dragiša Mišović (RS)
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2020-12-23
- Volume
- 13
- Issue
- 1
- Pages
- 15
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC7822481
- OpenAlex
- W3115139277
- Cited by
- 81
- References
- 51
- Citations by year
- 2026: 5 · 2025: 19 · 2024: 13 · 2023: 23 · 2022: 16 · 2021: 4 · 2018: 1
- FWCI
- 7.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- RIMI (Institute for Medical Research, University of Belgrade) (submittedVersion, cc-by)
- Funders
- Ministarstvo Prosvete, Nauke i Tehnološkog Razvoja (451-03-68/, 451‐03‐68/2020‐14/200015, 200015, 451-03-68/2020, 451-03-68 / 2020-14)
- 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, Mediterranean diet, low-fat diet, caloric restriction, fatty acid status, serum phospholipids, erythrocyte phospholipids, hepatic steatosis, n-6/n-3 ratio, docosahexaenoic acid, monounsaturated fatty acids, cardiometabolic risk, insulin resistance, weight loss, obesity
- MeSH terms
- Cardiometabolic Risk Factors, Adult, Blood Glucose, Body Weight, Fatty Acids, Humans, Liver, Male, Diet, Fat-Restricted, Caloric Restriction, Diet, Mediterranean, Waist Circumference, Non-alcoholic Fatty Liver Disease
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