The Mediterranean diet in fatty liver diseases

reference

Abenavoli L., Greco M., Milic N. et al. Effect of the Mediterranean diet and antioxidant formulation in non -alcoholic fatty liver disease: a randomized study. nutrients . 2017; 9 (870).

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randomized, prospective 6-month study with 3 cohorts (A, B, C): nutrition intervention alone (a); Dietary intervention with antioxidant supplementation (B); and control without treatment (c).

participant

Fifty Caucasians, overweight (BMI> 25 kg/m 2 ) Men and women with non -alcoholic fatty liver disease (NAFLD) were recruited from an outpatient clinic for gastroenterology in Italy; The NAFLD diagnosis was based on Hamaguchi ultrasound scoring. Patitis B, hepatitis C, heart disease, kidney disease, autoimmune diseases, leisure drug use, insulin treatment, excessive alcohol consumption and exposure to environmental toxins related to liver fatigue were excluded from the study.

Intervention

group A (n = 20) followed a low-calorie Mediterranean diet (1,400-1,600 kcal/day), while group B (n = 20) followed a low-calorie Mediterranean diet, which was supplemented with antioxidants. Macronutrients were divided into the intervention groups of the Mediterranean diet as follows: 50 % to 60 % carbohydrates; 15 % to 20 % protein, with about 50 % of protein sources from vegetables; Less than 30 % simple and polyunsaturated fats with less than 10 % saturated fatty acids; Less than 300 mg cholesterol per day; and 25 to 30 grams a day fiber. Group B received 2 pills daily Bilirel-Antioxidans supplement, which consists of artichoke, daring thistle, L-methionine, earth smoke and L-glutathione.

Group C (n = 10) did not change your lifestyle or her existing pharmacological (medication) regime.

study parameters evaluated

anthropometric parameters, blood pressure, lipid profile, homeostatic model evaluation of insulin resistance (Homa-IR), transaminases (serum level from alanine aminotransferase, aspartate aminotransferase and gamma glutayl-transplace) and liver fibrosis were assessed after 6 months. The liver fibrosis was assessed by means of a transient elastography, and a fat liver index was used to predict the likelihood of steatosis.

important knowledge

After 6 months of treatment, group A was a significant weight reduction compared to group C (control) (–6 %vs. –0.5 %, p = 0.0001), BMI (–7.5 %vs. –0.45 %, p = 0.0001), triglycerides (–32.16 vs. +2.8 %, p = 0.001), total cholesterol (-14.8 % vs. +9.3 %, p = 0.0001), triglyceride-glucose index (–3.3 % vs. +1 %, p = 0.020), fat liver index (-19 % vs. +4.7 % p = 0.017) and transient elastography (–21 % vs. +8.7 %, p = 0.001). Similar significant reductions were observed in Group B cohort compared to the control group. Compared to group A, Group B Wies significant reductions of the Homa-IR (–43 % compared to +6.2 %, p = 0.0001), insulin (–38 % vs. +10 %, p = 0.0001) and soberly glucose (–11 % vs. p = 0.016). These results show that a Mediterranean diet significantly reduces anthropometric parameters and lipid parameters and improves the transient elastography in patients with NAFLD. The addition of antioxidants can have the additional advantage of improving insulin -related biomarkers.

practice implications

Many observation studies have shown that patients with NAFLD have a nutritional pattern that is generally rich in calories, rich in saturated fatty acids, arm of polyunsaturated fats and arm of antioxidants, with an excessive carbohydrate recording from simple sugar 1-5 and a considerable amount of calories from Soft drinks, including lemonades and juices.

doctors who take care of these patients should be aware of their eating habits and ultimately promote a transition to a Mediterranean diet or diet that reduces simple carbohydrates and saturated fats and promotes a higher absorption of fruit and vegetables. Patients should also be encouraged to eliminate corn syrup with high fructose content - fructose is not metabolized in the same speed -limiting way as glucose, so that it directly promotes the fat deposit in the liver.

If overweight patients are able to lose about 7 % to 10 % of their body weight, the steatosis begins. ^{8-12 In a study, the steatosis disappeared in 90 % of NAFLD patients who had lost more than 10 % body weight. 13 Ultimately, the hepatic steatosis begins to improve when the patients are in the position, To do sports and change your diet.}

The non -alcoholic fat liver disease is insidious because most patients are asymptomatic and serum transaminases can be misleading.

Many specialists predict that in the next 15 to 20 years the main reason for an orthotropic liver transplantation will be a fatty liver that will displace hepatitis C and alcoholism. ^{14 It is currently estimated that 20 % to 30 % of the simple steatosis to Nash, the inflammatory stage of the NAFLD, and 7 % to 25 % of the nash to a cirrhose progress. fifteen nobody has identified a single mechanism that triggers the progress of simple steatosis to nafld; However, several studies show that NAFLD occurs more often in patients with metabolic syndrome and its subgroups.}

The non -alcoholic fat liver disease is insidious because most patients are asymptomatic and serum transaminases can be misleading. Our approach for patients with NAFLD should include early detection together with suitable nutritional and lifestyle recommendations, such as: B. the Mediterranean diet coupled with movement.