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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 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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What should we advise MAFLD patients to eat and drink?
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Monserrat-Mesquida, M., Bouzas, C., Mascaró, C. M., Tejada, S., & Sureda, A. (2023) · Fermentation · doi:10.3390/fermentation9040395 · Cited by 6
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“this diet consists of a balanced polyunsaturated fatty acids omega-3 omega-6 ratio along with consumption of complex carbohydrates and fibers in high content (Anania et al., 2018).”
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Kalaitzakis, Z. E., Giahnakis, E., Κoutroubakis, I. E., Mouzas, I., & Kalaitzakis, E. (2024) · Digestive Diseases and Sciences · doi:10.1007/s10620-023-08223-6 · Cited by 1
“The effect of this diet on patients with non-alcoholic fatty liver disease (NAFLD) and, in particular nonalcoholic steatohepatitis (NASH), has been widely studied [9, 10].”
BackgroundMetabolic dysfunction-associated steatotic liver disease in children and adolescents
Cheng, K., & Rosenthal, P. J. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99649-5.00011-x · Cited by 1
In Vitro Modeling of Fat Deposition in Metabolic Dysfunction-associated Steatotic Liver Disease
Bao, Q., Zhang, X., Chen, Y., Wang, T., & Siqin, B. (2024) · Journal of Visualized Experiments · doi:10.3791/66810 · Cited by 1
Moradi, S., Saber, A., Moradinazar, M., Heydarian, A., Cheshmeh, S., Sadeghi, F., & Pasdar, Y. (2024) · Journal of Kermanshah University of Medical Sciences · doi:10.5812/jkums-142759 · Cited by 1
Impact of Mediterranean Diet Adherence in Early Pregnancy on Nausea, Vomiting, and Constipation
Barroso-Ruiz, I., Ibáñez, N. C., Benito-Villena, R., Martín‐Peláez, S., & Amezcua‐Prieto, C. (2025) · Maternal and Child Health Journal · doi:10.1007/s10995-025-04078-7 · Cited by 1
Liver Disease and Nutrition: An Overview
Sahu, S., Bhavanam, S., & Younas, S. (2025) · Springer eBooks · doi:10.1007/978-3-031-32047-7_185-1 · Cited by 1
Wu, Z., Liang, Y., Zeng, L., Fang, J., & He, J. (2025) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-01015-w · Cited by 1
“In contrast, the Mediterranean diet (MD), abundant in polyunsaturated fats, polyphenols and vitamins, stands out for its antioxidant, anti-inflammatory, and lipid-lowering properties, making it a potentially effective strategy for mitigating NAFLD [14].”
Diagnosis and Management of Pediatric Non-Alcoholic Fatty Liver Disease: An Overview
Dop, D., Pădureanu, V., Pădureanu, R., Niculescu, C. E., Niculescu, Ș. A., & Marcu, I. R. (2025) · Metabolites · doi:10.3390/metabo15120792 · Cited by 1
“The Mediterranean diet, low in saturated fat and animal protein and high in fiber, antioxidants and monosaturated fatty acids, is a healthy dietary option that prevents obesity and the development of liver steatosis [80].”
Gluten’s silent strike: Unmasking its impact on liver health
Kalra, S., Joshi, S., Goyal, M. K., Goyal, K., Singh, B., Vuthaluru, A. R., & Goyal, O. (2025) · World Journal of Gastrointestinal Pathophysiology · doi:10.4291/wjgp.v16.i4.111957 · Cited by 1
“Mediter-ranean-pattern diets improve hepatic steatosis and insulin sensitivity in NAFLD, supporting their adoption when gluten avoidance is required[47].”
Wei, Y., Ye, L., Li, M., Yan, B., Lin, Y., Lai, S., Mo, Z., & Tang, C. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1752891 · Cited by 1
Gökcen, B. B., Kurtuluş, İ., Kabak, N., Budán, F., Ağagündüz, D., & Szép, D. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1740363 · Cited by 1
Choline and DNA methylation: impact across metabolic, oncogenic and neurodevelopmental disorders
Sareen, S., Bakovic, M., & Cho, C. E. (2026) · Clinical Epigenetics · doi:10.1186/s13148-026-02086-0 · Cited by 3
“Currently, MASLD treatments are based on lifestyle changes, such as dietary modifications and physical activity, as there is no consensus on effective pharmacological therapies [72].”
Hepatic Biomarkers in Diabetes as Modulated by Dietary Phytochemicals
Basu, A., Basu, P., & Lyons, T. J. (2016) · Exposure and Health · doi:10.1007/978-94-007-7742-2_35-1 · Cited by 1
Arterial Blood Pressure and Lifestyle Variability: In Quest of a Comprehensive Approach
Trovato, G. M. (2017) · American Journal of Hypertension · doi:10.1093/ajh/hpx080 · Cited by 1
Review on the Role of Fructose in Non-Alcoholic Fatty Liver Diseases
Umaru, I. J., & Emmanuel, O. C. (2022) · International Journal of Scientific and Management Research · doi:10.37502/ijsmr.2022.5212 · Cited by 2
“The biological mechanisms involved in these improvements may include the antiinflammatory and lipid-lowering properties of the Mediterranean diet and its impact on the composition of the gut microbiota (Anania et al., 2018; Marjot et al., 2020).”
BackgroundEfficacy of nutrition therapy with food rich in methionine for treating nonalcoholic fatty liver
Morales‐Romero, J., León, M. C. O., Hernández-Gutierrez, H., Bahena-Cerón, R. A., Miranda-Reza, A., Marin-Carmona, J. A., Rodríguez-Romero, E., Mora-Herrera, S. I., García-Román, J., Pérez‐Carreón, J. I., et al. (2023) · Archivos Latinoamericanos de Nutrición · doi:10.37527/2023.73.2.004 · Cited by 1
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Intelligent identification of coal miners with fatty liver under a cascade reduction strategy
Bian, K., Zhou, M., Zhang, Z., Hu, F., Lipeng, G., & Wang, K. (2025) · Engineering Analysis with Boundary Elements · doi:10.1016/j.enganabound.2025.106262 · Cited by 1
Ernährung bei Diabetes mellitus Typ 2
Brede, S., & Lehnert, H. (2018) · Der Internist · doi:10.1007/s00108-018-0531-1 · Cited by 1
Banitalebi, E., Tavasoli, Z., Jafari, T., & Ghahfarrokhi, M. M. (2020) · Journal of Shahrekord University of Medical Sciences · doi:10.34172/jsums.2020.30 · Cited by 1
Haigh, L., McPherson, S., Mathers, J. C., & Anstee, Q. M. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045922 · Cited by 1
Therapie von Begleiterkrankungen: Diabetes mellitus und Dyslipoproteinämie
Apostolopoulou, M., & Roden, M. (2022) · Springer eBooks · doi:10.1007/978-3-662-62484-5_20 · Cited by 1
Mazzarelli, C., Angrisani, D., & Viganò, R. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.07.025 · Cited by 1
Atefi, M., Entezari, M. H., & Vahedi, H. (2022) · Research Square · doi:10.21203/rs.3.rs-2211351/v1 · Cited by 1
The gut microbiome and gut-liver axis in NAFLDPreprint
Guo, C., Ji, J., Wu, J., Wu, L., Feng, J., Li, J., Yu, Q., Dai, W., Li, Y., & Zheng, Y. (2024) · doi:10.22541/au.170666810.08665505/v1
Metadata
- 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
- 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 › Hepatology › 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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