Mediterranean diet as the ideal model for preventing non-alcoholic fatty liver disease (NAFLD)

The prevalence of nonalcoholic fatty liver disease (NAFLD) has dramatically increased in the 2–3 last decades and it represents the most frequent global cause of liver disease, affecting 25% to 45% of adults in most studies (1).

The worldwide elevation in the population rates of NAFLD has come in parallel with rising unprecedented pandemics of obesity and diabetes. There is no specific medication for NAFLD and dietary/lifestyle modifications are the main foundations for the treatment of NAFLD.

They are also very likely to be effective for its primary prevention. In this context, a dietary pattern that meets most requirements to become the ideal model for the prevention of NAFLD is the traditional Mediterranean diet (2).

In addition to the potential for preventing NAFLD, the Mediterranean diet has sufficiently demonstrated its great ability to improve cardiovascular health. The accrual of prospective and well conducted studies showing cardiovascular benefits associated with better adherence to a high-quality food pattern is superior for the traditional Mediterranean food pattern than for any other dietary pattern (3).

Also, only for the Mediterranean diet, secondary prevention randomized trials (4,5) and a large primary prevention trial (6) have demonstrated substantial benefits. This large primary prevention trial is the Spanish PREDIMED trial (6,7), that included 7,447 initially healthy participants (42.5% of them were men aged 55–80 years and 57.5% were women aged 60–80 years).

All participants were at high risk of cardiovascular disease and they were randomized to 3 equally sized groups to receive 3 different dietary interventions: (I) a Mediterranean Diet supplemented with extra-virgin olive oil (MedDiet + EVOO); (II) a Mediterranean diet supplemented with mixed nuts (MedDiet + nuts); or (III) a control diet (low-fat diet).

CITATION  Hepatobiliary Surg Nutr. 2020 Jun;9(3):379-381.  doi: 10.21037/hbsn.2019.11.13