Mediterranean diet and nonalcoholic fatty liver disease
Open accessAbstract
Nonalcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver disease, and is characterized by a wide spectrum of fat-liver disorders that can result in severe liver disease and cirrhosis. Inflammation and oxidative stress are the major risk factors involved in the pathogenesis of NAFLD. Currently, there is no consensus concerning the pharmacological treatment of NAFLD. However, lifestyle interventions based on exercise and a balanced diet for quality and quantity, are considered the cornerstone of NAFLD management. Mediterranean diet (MD), rich in polyunsaturated fats, polyphenols, vitamins and carotenoids, with their anti-inflammatory and anti-oxidant effects, has been suggested to be effective in preventing cardiovascular risk factors. In adults, MD has also been demonstrated to be efficacious in reducing the risk of metabolic syndrome. However, few studies are available on the effects of the MD in both adult and pediatric subjects with NAFLD. Thus, the aims of the present narrative review are to analyze the current clinical evidence on the impact of MD in patients with NAFLD, and to summarize the main mechanisms of action of MD components on this condition.
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Omega-3 PUFAs, specifically EPA and DHA, have antioxidant and anti-inflammatory properties.
“omega-3 PUFAs, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are renowned for their antioxidant and anti-inflammatory properties (95–97).”
From Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility (2024) · cites this paper as [96]
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Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease
Trovato, F. M., Martines, G. F., Brischetto, D., Trovato, G. M., & Catalano, D. (2016) · World Journal of Hepatology · doi:10.4254/wjh.v8.i33.1459 · Cited by 53 · see citing works
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Pediatric nonalcoholic fatty liver disease: A clinical and laboratory challenge
Pacifico, L. (2010) · World Journal of Hepatology · doi:10.4254/wjh.v2.i7.275 · Cited by 49 · see citing works
Effects of fatty acids on hepatic gene expression
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Saturated fatty acid intake decreases serum adiponectin levels in subjects with type 1 diabetes
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Nonalcoholic Fatty Liver Disease and Cardiovascular Disease Risk
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MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease
Eslam, M., Sanyal, A. J., George, J., Sanyal, A., Neuschwander-Tetri, B., Tiribelli, C., Kleiner, D. E., Brunt, E., Bugianesi, E., Yki-Järvinen, H., et al. (2020) · Gastroenterology · doi:10.1053/j.gastro.2019.11.312 · Cited by 3,286 · see citing works
Treatment of NAFLD with diet, physical activity and exercise
Romero-Gómez, M., Zelber-Sagi, S., & Trenell, M. (2017) · Journal of Hepatology · doi:10.1016/j.jhep.2017.05.016 · Cited by 1,347 · see citing works
ESPEN guideline on clinical nutrition in liver disease
Plauth, M., Bernal, W., Dasarathy, S., Merli, M., Plank, L. D., Schütz, T., & Bischoff, S. C. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.12.022 · Cited by 674 · see citing works
NAFLD as a Continuum: From Obesity to Metabolic Syndrome and Diabetes
Godoy-Matos, A. F., Silva Júnior, W. S., & Valerio, C. M. (2020) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-020-00570-y · Cited by 643 · see citing works
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“Those who followed a Mediterranean diet showed a better decrease of liver transaminase, body mass index (BMI) changes, and improvement in IR [152, 153].”
BackgroundESPEN practical guideline: clinical nutrition in liver disease
Bischoff, S. C., Bernal, W., Dasarathy, S., Merli, M., Plank, L. D., Schütz, T., & Plauth, M. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.09.001 · Cited by 383 · see citing works
NAFLD in children: new genes, new diagnostic modalities and new drugs
Nobili, V., Alisi, A., Valenti, L. V. C., Miele, L., Feldstein, A. E., & Alkhouri, N. (2019) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-019-0169-z · Cited by 311 · see citing works
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Zelber‐Sagi, S., Salomone, F., & Mlynarsky, L. (2017) · Liver International · doi:10.1111/liv.13435 · Cited by 273 · see citing works
Papadaki, A., Nolen‐Doerr, E., & Mantzoros, C. S. (2020) · Nutrients · doi:10.3390/nu12113342 · Cited by 266 · see citing works
Nutrition, inflammation and liver-spleen axis
Barrea, L., Somma, C. D., Muscogiuri, G., Tarantino, G., Tenore, G. C., Orio, F., Colao, A., & Savastano, S. (2017) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2017.1353479 · Cited by 265 · see citing works
Non‐alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management
Huang, T. (., Behary, J., & Zekry, A. (2020) · Internal Medicine Journal · doi:10.1111/imj.14709 · Cited by 227 · see citing works
Ditano-Vázquez, P., Torres-Peña, J. D., Valle, F. G., Pérez-Caballero, A. I., Rodríguez, P. D., López‐Miranda, J., Katsiki, N., Delgado‐Lista, J., & Alvarez-Sala-Walther, L. A. (2019) · Nutrients · doi:10.3390/nu11112833 · Cited by 242 · see citing works
Nonalcoholic fatty liver disease in adults: current concepts in etiology, outcomes, and management
Marjot, T., Moolla, A., Cobbold, J. F., Hodson, L., & Tomlinson, J. W. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnz009 · Cited by 228 · see citing works
Sandireddy, R., Sakthivel, S., Gupta, P., Behari, J., Tripathi, M., & Singh, B. K. (2024) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2024.1433857 · Cited by 229 · see citing works
Impact of Nutritional Changes on Nonalcoholic Fatty Liver Disease
Perdomo, C. M., Frühbeck, G., & Escalada, J. (2019) · Nutrients · doi:10.3390/nu11030677 · Cited by 217 · see citing works
Cai, H., Qin, Y.-L., Shi, Z.-Y., Chen, J.-H., Zeng, M.-J., Zhou, W., Chen, R.-Q., & Chen, Z.-Y. (2019) · BMC Gastroenterology · doi:10.1186/s12876-019-1132-8 · Cited by 205 · see citing works
Health Benefits of Mediterranean Diet
Martini, D. (2019) · Nutrients · doi:10.3390/nu11081802 · Cited by 200 · see citing works
Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications
Tana, C., Ballestri, S., Ricci, F., Vincenzo, A. D., Ticinesi, A., Gallina, S., Giamberardino, M. A., Cipollone, F., Sutton, R., Vettor, R., et al. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16173104 · Cited by 191 · see citing works
“Results from the available studies suggest that the Mediterranean diet is effective in patients with NAFLD but there is still need for trials with larger sample sizes [100,101].”
BackgroundNutraceutical Approach to Non-Alcoholic Fatty Liver Disease (NAFLD): The Available Clinical Evidence
Cicero, A. F. G., Colletti, A., & Bellentani, S. (2018) · Nutrients · doi:10.3390/nu10091153 · Cited by 185 · see citing works
Diet and exercise in NAFLD/NASH: Beyond the obvious
Semmler, G., Datz, C., Reiberger, T., & Trauner, M. A. (2021) · Liver International · doi:10.1111/liv.15024 · Cited by 183 · see citing works
Mechanisms of Non-Alcoholic Fatty Liver Disease in the Metabolic Syndrome. A Narrative Review
Rinaldi, L., Pafundi, P. C., Galiero, R., Caturano, A., Morone, M. V., Silvestri, C., Giordano, M., Salvatore, T., & Sasso, F. C. (2021) · Antioxidants · doi:10.3390/antiox10020270 · Cited by 178 · see citing works
“PUFAs are also responsible for the regulation of three major transcription factors involved in several pathways of liver metabolism of carbohydrates and lipids [113].”
BackgroundInfluentialRole of gut microbiota via the gut-liver-brain axis in digestive diseases
Ding, J., Jin, Z., Yang, X., Lou, J., Shan, W., Hu, Y., Du, Q., Liao, Q., Xie, R., & Xu, J. (2020) · World Journal of Gastroenterology · doi:10.3748/wjg.v26.i40.6141 · Cited by 172 · see citing works
Katsagoni, C. N., Papatheodoridis, G. V., Ioannidou, P., Deutsch, M., Alexopoulou, A., Papadopoulos, N., Papageorgiou, M.-V., Fragopoulou, E., & Kontogianni, M. D. (2018) · British Journal of Nutrition · doi:10.1017/s000711451800137x · Cited by 167 · see citing works
Nonalcoholic Fatty Liver Disease and Obesity Treatment
Brunner, K. T., Henneberg, C. J., Wilechansky, R. M., & Long, M. T. (2019) · Current Obesity Reports · doi:10.1007/s13679-019-00345-1 · Cited by 167 · see citing works
Trovato, F. M., Martines, G. F., Brischetto, D., Catalano, D., Musumeci, G., & Trovato, G. M. (2015) · Liver International · doi:10.1111/liv.12957 · Cited by 149 · see citing works
Adherence to Mediterranean Diet and Non-Alcoholic Fatty Liver Disease: Effect on Insulin Resistance
Baratta, F., Pastori, D., Polimeni, L., Bucci, T., Ceci, F., Calabrese, C. M., Ernesti, I., Pannitteri, G., Violi, F., Angelico, F., et al. (2017) · The American Journal of Gastroenterology · doi:10.1038/ajg.2017.371 · Cited by 146 · see citing works
Zelber‐Sagi, S., Godos, J., & Salomone, F. (2016) · Therapeutic Advances in Gastroenterology · doi:10.1177/1756283x16638830 · Cited by 142 · see citing works
Omega-3 polyunsaturated fatty acids as a treatment strategy for nonalcoholic fatty liver disease
Jump, D. B., Lytle, K. A., Depner, C. M., & Tripathy, S. (2018) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2017.07.007 · Cited by 142 · see citing works
Muzurović, E., Peng, C. C., Belanger, M. J., Sanoudou, D., Mikhailidis, D. P., & Mantzoros, C. S. (2022) · Hypertension · doi:10.1161/hypertensionaha.122.17982 · Cited by 138 · see citing works
The Epidemiology, Risk Profiling and Diagnostic Challenges of Nonalcoholic Fatty Liver Disease
Iqbal, U., Perumpail, B. J., Akhtar, D. H., Kim, D., & Ahmed, A. (2019) · Medicines · doi:10.3390/medicines6010041 · Cited by 137 · see citing works
“Therefore, experts recommend the use of the Mediterranean diet for weight loss and protection against NAFLD [82,83].”
BackgroundRelevant Aspects of Nutritional and Dietary Interventions in Non-Alcoholic Fatty Liver Disease
Hernández‐Rodas, M. C., Valenzuela, R., & Videla, L. A. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms161025168 · Cited by 130 · see citing works
A Fad too Far? Dietary Strategies for the Prevention and Treatment of NAFLD
Moore, M. P., Cunningham, R. P., Dashek, R. J., Mucinski, J. M., & Rector, R. S. (2020) · Obesity · doi:10.1002/oby.22964 · Cited by 128 · see citing works
Inflammation initiates a vicious cycle between obesity and nonalcoholic fatty liver disease
Luo, Y., & Lin, H. (2020) · Immunity Inflammation and Disease · doi:10.1002/iid3.391 · Cited by 127 · see citing works
Torre, S. D. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.572490 · Cited by 118 · see citing works
“Conversely, diets enriched in ω3 polyunsaturated FAs (ω3 PUFAs), such as the Mediterranean diet (133), may be particularly effective in counteracting the early stages of NAFLD (134), limiting insulin resistance, oxidative stress, DNL and TG deposition in the liver (135, 136) and preventing the development of liverasso…”
BackgroundSchnabl, B., Damman, C. J., & Carr, R. M. (2025) · Journal of Clinical Investigation · doi:10.1172/jci186423 · Cited by 126 · see citing works
He, K., Li, Y., Guo, X., Zhong, L., & Tang, S. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520000914 · Cited by 113 · see citing works
Eslamparast, T., Tandon, P., & Raman, M. (2017) · Nutrients · doi:10.3390/nu9080800 · Cited by 108 · see citing works
Alimentary regimen in non-alcoholic fatty liver disease: Mediterranean diet
Abenavoli, L. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i45.16831 · Cited by 104 · see citing works
Petermann-Rocha, F. E., Wirth, M. D., Boonpor, J., Parra-Soto, S. L., Zhou, Z., Mathers, J. C., Livingstone, K. M., Forrest, E. H., Pell, J. P., Ho, F. K. W., et al. (2023) · BMC Medicine · doi:10.1186/s12916-023-02793-y · Cited by 105 · see citing works
Miller, D. M., McCauley, K. F., & Dunham‐Snary, K. J. (2025) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.70132 · Cited by 125 · see citing works
“Dietary interventions such as the Mediterranean diet, which emphasises polyunsaturated fats, polyphenols and omega-3 fatty acids, have been shown to improve liver histology and metabolic parameters [201].”
Mediterranean diet and NAFLD: what we know and questions that still need to be answered
Plaz Torres, M. C., Aghemo, A., Lleo, A., Bodini, G., Furnari, M., Marabotto, E., Miele, L., & Giannini, E. G. (2019) · Nutrients · doi:10.3390/nu11122971 · Cited by 97 · see citing works
Suárez, M., Boqué, N., Bas-Prior, J. M. D., Mayneris‐Perxachs, J., Arola, L., & Caimari, A. (2017) · Nutrients · doi:10.3390/nu9101052 · Cited by 93 · see citing works
The influence of dietary fatty acids on liver fat content and metabolism
Hodson, L., Rosqvist, F., & Parry, S. A. (2019) · Proceedings of The Nutrition Society · doi:10.1017/s0029665119000569 · Cited by 93 · see citing works
“As a Mediterranean diet consists of a relatively high intake of nutrient dense foods such as fruit and vegetables((69)), it is challenging to isolate the effects of MUFA as it is plausible that other components of a Mediterranean diet are beneficial for reductions in IHTAG((70)); elucidating the influence of specific…”
Puri, P., Dhiman, R. K., Taneja, S., Tandon, P., Merli, M., Anand, A. C., Arora, A., Acharya, S. K., Benjamin, J., Chawla, Y. K., et al. (2020) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2020.09.003 · Cited by 92 · see citing works
George, E. S., Forsyth, A. K., Itsiopoulos, C., Nicoll, A., Ryan, M. C., Sood, S. S., Roberts, S. K., & Tierney, A. C. (2018) · Advances in Nutrition · doi:10.1093/advances/nmx007 · Cited by 91 · see citing works
Shively, C. A., Appt, S. E., Vitolins, M. Z., Uberseder, B., Michalson, K. T., Silverstein‐Metzler, M. G., & Register, T. C. (2019) · Obesity · doi:10.1002/oby.22436 · Cited by 91 · see citing works
“Overall, there was no significant difference in calories consumed between treatment groups (2 × 4 ANCOVA F[1,34] = 2.”
BackgroundInfluentialRajapakse, J., Khatiwada, S., Akon, A. C., Yu, K. L., Shen, S., & Zekry, A. (2023) · Gut Microbes · doi:10.1080/19490976.2023.2240031 · Cited by 94 · see citing works
“One emerging dietary model in this area is the Mediterranean diet, which has been recognized for some time for its association with reduced risk of several conditions, including obesity, T2DM and NAFLD.(62,63) The main characteristics of the Mediterranean diet are a beneficial fatty acid profile (specifically, low sat…”
BackgroundA review of non‐alcoholic fatty liver disease in non‐obese and lean individuals
Ahadi, M., Molooghi, K., Masoudifar, N., Namdar, A. B., Vossoughinia, H., & Farzanehfar, M. (2020) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.15353 · Cited by 90 · see citing works
Olive oil antioxidants and non-alcoholic fatty liver disease
Abenavoli, L., Milanović, M., Milić, N., Luzza, F., & Giuffrè, A. M. (2019) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2019.1634544 · Cited by 83 · see citing works
Ristic-Medic, D., Kovacic, M., Takic, M., Arsic, A., Petrovic, S., Paunovic, M., Jovicic, M., & Vucic, V. (2020) · Nutrients · doi:10.3390/nu13010015 · Cited by 81 · see citing works
Beyond Body Weight-Loss: Dietary Strategies Targeting Intrahepatic Fat in NAFLD
Worm, N. (2020) · Nutrients · doi:10.3390/nu12051316 · Cited by 76 · see citing works
Salomone, F., Wajcman, D. I., Isakov, N. F., Webb, M., Grosso, G., Godos, J., Galvano, F., Shibolet, O., Kariv, R., & Zelber‐Sagi, S. (2020) · JHEP Reports · doi:10.1016/j.jhepr.2020.100069 · Cited by 71 · see citing works
Mambrini, S. P., Grillo, A., Colosimo, S., Zarpellon, F., Pozzi, G., Furlan, D., Amodeo, G., & Bertoli, S. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1426551 · Cited by 70 · see citing works
Pancreatic and mucosal enzymes in choline phospholipid digestion
Nilsson, Å., & Duan, R. (2018) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00320.2018 · Cited by 68 · see citing works
Non-Alcoholic Fatty Liver Disease in Obese Youth With Insulin Resistance and Type 2 Diabetes
Scapaticci, S., D’Adamo, E., Mohn, A., Chiarelli, F., & Giannini, C. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.639548 · Cited by 72 · see citing works
Race and Ethnicity in Non-Alcoholic Fatty Liver Disease (NAFLD): A Narrative Review
Riazi, K., Swain, M. G., Congly, S. E., Kaplan, G. G., & Shaheen, A. A. (2022) · Nutrients · doi:10.3390/nu14214556 · Cited by 71 · see citing works
Khalatbari‐Soltani, S., Imamura, F., Brage, S., Rolfe, E. D. L., Griffin, S. J., Wareham, N. J., Marques-Vidal, P. M., & Forouhi, N. G. (2019) · BMC Medicine · doi:10.1186/s12916-019-1251-7 · Cited by 67 · see citing works
Health benefits of Mediterranean diet in nonalcoholic fatty liver disease
Abenavoli, L., Di Renzo, L., Boccuto, L., Alwardat, N., Gratteri, S., & De Lorenzo, A. (2018) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2018.1503947 · Cited by 62 · see citing works
Parra-Vargas, M., Rodriguez‐Echevarría, R., & Jiménez‐Chillarón, J. C. (2020) · Nutrients · doi:10.3390/nu12123860 · Cited by 63 · see citing works
NAFLD-Associated HCC: Progress and Opportunities
Geh, D., Anstee, Q. M., & Reeves, H. L. (2021) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s272213 · Cited by 61 · see citing works
Montemayor, S., Bouzas, C., Mascaró, C. M., Casares, M., Llompart, I., Abete, I., Angullo-Martinez, E., Zulet, M. Á., Martínez, J. A., & Tur, J. A. (2022) · Nutrients · doi:10.3390/nu14112223 · Cited by 62 · see citing works
“NAFLD is associated with visceral obesity, insulin resistance, dyslipidemia, and chronic inflammation, all of which are features of MetS, and the MedDiet may improve NAFLD by modulating the presence of these conditions [7].”
BackgroundBischoff, S. C., Barazzoni, R., Busetto, L., Campmans-Kuijpers, M. J. E., Cardinale, V., Chermesh, I., Eshraghian, A., Kani, H. T., Khannoussi, W., Lacaze, L., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.07.003 · Cited by 61 · see citing works
Motta, B. M., Masarone, M., Torre, P., & Persico, M. (2023) · Cancers · doi:10.3390/cancers15225458 · Cited by 60 · see citing works
“A Mediterranean diet can reduce hepatic steatosis, improves plasma lipid levels and fatty acid oxidation by reducing their accumulation, and has a synergistic effect in reducing car-Cancers diovascular risk [86,87].”
BackgroundMansour‐Ghanaei, F., Hadi, A., Pourmasoumi, M., Joukar, F., Golpour, S., & Najafgholizadeh, A. (2018) · Phytotherapy Research · doi:10.1002/ptr.6130 · Cited by 60 · see citing works
A Molecular Insight into the Role of Antioxidants in Nonalcoholic Fatty Liver Diseases
Ezhilarasan, D., & Thangavelu, L. P. (2022) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2022/9233650 · Cited by 63 · see citing works
“Mediterranean diet generally contains low carbohydrate, rich in antioxidants and anti-in fl ammatory agents including carotenoids, polyphenols, fi ber, polyunsaturated fats, and vitamins [46].”
Guess, N. D. (2018) · Nutrients · doi:10.3390/nu10091245 · Cited by 57 · see citing works
“A Mediterranean-style diet may also help lower liver fat [36].”
BackgroundThe Role of Vitamins in Non-Alcoholic Fatty Liver Disease: A Systematic Review
Abe, R. A. M., Masroor, A., Khorochkov, A., Prieto, J., Singh, K. B., Nnadozie, M. C., Abdal, M., Shrestha, N., & Mohammed, L. (2021) · Cureus · doi:10.7759/cureus.16855 · Cited by 55 · see citing works
“Some reports state that Vitamin C decreases mitochondrial ROS generation, increases the levels of antioxidant enzymes such as superoxide dismutase and glutathione peroxidase, and improves the electron transport chain activity in the liver [16,21].”
BackgroundInfluentialBischoff, S. C., Barazzoni, R., Busetto, L., Campmans-Kuijpers, M. J. E., Cardinale, V., Chermesh, I., Eshraghian, A., Kani, H. T., Khannoussi, W., Lacaze, L., et al. (2022) · United European Gastroenterology Journal · doi:10.1002/ueg2.12280 · Cited by 54 · see citing works
Moosavian, S. P., Arab, A., & Paknahad, Z. (2019) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.10.008 · Cited by 55 · see citing works
Park, S., Noureddin, M., Boushey, C. J., Wilkens, L. R., & Setiawan, V. W. (2020) · Current Developments in Nutrition · doi:10.1093/cdn/nzaa024 · Cited by 55 · see citing works
“There are several proposed mechanisms linking diet quality to NAFLD risk including anti-inflammatory and antioxidant properties of certain diet components such as fiber, monounsaturated and omega-3 fatty acids, and phytosterols (39, 40).”
BackgroundDiabetes as a risk factor for MASH progression
Gancheva, S., Roden, M., & Castéra, L. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111846 · Cited by 59 · see citing works
Dietary and Pharmacological Treatment of Nonalcoholic Fatty Liver Disease
Jeznach-Steinhagen, A. E., Ostrowska, J., Czerwonogrodzka–Senczyna, A., Boniecka, I., Shahnazaryan, U., & Kuryłowicz, A. (2019) · Medicina · doi:10.3390/medicina55050166 · Cited by 54 · see citing works
“Favorable effects were also observed in patients on a Mediterranean diet and a diet based on the healthy food pyramid, including low and medium IG products [13].”
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Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease
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“307,308 The gut ‒ liver axis affects microbial ingenuity with hepatic resilience, channeling metabolic and immune dialogs via the portal vein.”
Echocardiography and NAFLD (non-alcoholic fatty liver disease)
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The Gut Microbiome and Ferroptosis in MAFLD
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Intestinal Barrier Function in the Pathogenesis of Nonalcoholic Fatty Liver Disease
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“…of 7 randomized controlled trials, drawn from an initial pool of 12,343 articles, revealed that these IF protocols, administered over 2 to 3 months, markedly lowered liver steatosis scores and metrics associated with obesity (including body mass index, overall body weight, and waist…”
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“The Mediterranean, the anti-inflammatory, plant-based diet has a dietary structure that helps reduce inflammation, replenish micronutrients, promote good microbiota, and help with insulin resistance [77 – 79].”
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Food and Nutrition in the Pathogenesis of Liver Damage
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“In this view, the Mediterranean diet, which includes fruit and vegetables, is considered an excellent diet, useful for the prevention of NAFLD (Non-alcoholic fatty liver disease) [8].”
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Perspectives on youth‐onset nonalcoholic fatty liver disease
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“…extensively tested dietary pattern and, in adults, there is consistent evidence that a MD treatment is associated with a reduction in he - patic fat 108 ; The Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits and vegetables, low-fat dairy, and unre-fined grains, has also…”
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“Mediterranean diet has been proven to be a gold standard for the prevention and therapy of the metabolic syndrome, obesity, and NAFLD [145 e 147], and although the data on patients with celiac disease are missing, it would be wise to advise patients with celiac disease and with obesity-related…”
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“Among the diets, the one that seems to have the greatest impact is the Mediterranean diet (MD), a diet low in saturated fats and animal proteins, rich in antioxidants and fiber, and with an adequate ratio between omega-6 and omega-3 [55].”
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“rich in antioxidants, monounsaturated fatty acids, saturated fatty acids, animal protein, and fiber [7].”
BackgroundInfluentialGut Microbiota at the Crossroad of Hepatic Oxidative Stress and MASLD
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The Hepatic Sinusoid in Chronic Liver Disease: The Optimal Milieu for Cancer
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The New Therapeutic Approaches in the Treatment of Non-Alcoholic Fatty Liver Disease
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“PUFAs, particularly omega-3 fatty acids, have been shown to be beneficial in preventing cardiovascular events [69].”
BackgroundDietary patterns in non-alcoholic fatty liver disease (NAFLD): Stay on the straight and narrow path!
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- Authors
- Anania, C., Perla, F. M., Olivero, F., Pacifico, L., & Chiesa, C.
- Affiliations
- Policlinico Umberto I (IT)
- Corresponding author
- Chiesa, Claudio
- Venue
- World Journal of Gastroenterology
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2018-05-21
- Volume
- 24
- Issue
- 19
- Pages
- 2083-2094
- ISSN
- 1007-9327 (ISSN-L)
- PMC
- PMC5960814
- OpenAlex
- W2803151742
- Cited by
- 353
- References
- 112
- Citations by year
- 2026: 23 · 2025: 45 · 2024: 46 · 2023: 47 · 2022: 33 · 2021: 42 · 2020: 39 · 2019: 30 · 2018: 18 · 2017: 13 · 2016: 10 · 2015: 4 · 2014: 3
- FWCI
- 4.61
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Gastroenterology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by-nc)
- 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
- Mediterranean diet, non-alcoholic fatty liver disease, polyphenols, polyunsaturated fatty acids, carotenoids, anti-inflammatory activity, antioxidant activity, oxidative stress, inflammation, metabolic syndrome, cardiovascular risk, lifestyle intervention, pediatric NAFLD, pathogenesis
- MeSH terms
- Gastrointestinal Microbiome, Adult, Child, Humans, Life Style, Lipids, Liver, Patient Compliance, Risk Factors, Exercise, Treatment Outcome, Oxidative Stress, Diet, Mediterranean, Lipid Metabolism, Non-alcoholic Fatty Liver Disease
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