Adherence to Mediterranean Diet and Non-Alcoholic Fatty... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: LIVER

Adherence to Mediterranean Diet and Non-Alcoholic Fatty Liver Disease: Effect on Insulin Resistance

Baratta, Francesco MD1,2,8; Pastori, Daniele MD1,2,8; Polimeni, Licia MD1; Bucci, Tommaso MD3; Ceci, Fabrizio MD4; Calabrese, Cinzia MD1; Ernesti, Ilaria MD5; Pannitteri, Gaetano MD6; Violi, Francesco MD1; Angelico, Francesco MD7; Del Ben, Maria MD1

1I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

2Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences—Sapienza University of Rome, Rome, Italy

3Department of Medical Specialties, Salerno University of Medicine, Salerno, Italy

4Department of Cellular Biotechnologies and Hematology, “La Sapienza” University, Policlinico Umberto I Hospital, Rome, Italy

5Department of Experimental Medicine, Section of Medical Pathophysiology, Endocrinology and Nutrition, Sapienza University, Rome, Italy

6Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy

7Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Correspondence: Daniele Pastori, MD, I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy. E-mail: [email protected]

8These author contributed equally to this work

Received 15 May 2017; accepted 10 August 2017

Guarantor of the article: Daniele Pastori, MD.

Specific author contributions: Francesco Violi, Francesco Angelico, Maria Del Ben.: study concept and design; interpretation of data; drafting of the manuscript; critical revision of the manuscript. Daniele Pastori: study concept and design; analysis and interpretation of data; statistical analysis; drafting of the manuscript; critical revision of the manuscript. Francesco Baratta: acquisition of data (administration of dietary questionnaire); interpretation of data; drafting of the manuscript; critical revision of the manuscript. Tommaso Bucci, Licia Polimeni, Fabrizio Ceci, Cinzia Calabrese, Ilaria Ernesti: acquisition of data; drafting of the manuscript; critical revision of the manuscript. Licia Polimeni: acquisition of data (ultrasound evaluation of liver steatosis); drafting of the manuscript; critical revision of the manuscript. All authors read and approved the final version of the manuscript.

Financial support: None.

Potential competing interests: None.

Abstract

Objectives:

The prevalence of cardiometabolic disorders, including non-alcoholic fatty liver disease (NAFLD), is increasing in western countries, because of changes in lifestyle and dietary habits. Mediterranean Diet (Med-Diet) is effective for cardiovascular prevention, but its relationship with NAFLD has been scarcely investigated.

Methods:

We included 584 consecutive outpatients presenting with one or more cardiovascular risk factor such as type 2 diabetes mellitus (T2DM), arterial hypertension, overweight/obesity, and dyslipidemia. Liver steatosis was assessed using ultrasonography. Med-Diet adherence was investigated by a validated semiquantitative nine-item dietary questionnaire; patients were divided into low, intermediate, and high adherence. Insulin resistance was defined by the 75th percentile of homeostasis model of insulin resistance (HOMA-IR; ≥3.8).

Results:

The mean age was 56.2±12.4 years and 38.2% were women. Liver steatosis was present in 82.7%, and its prevalence decreased from low to high adherence group (96.5% vs. 71.4%, P <0.001). In a multiple logistic regression analysis, hypertriglyceridemia (odds ratio (OR): 2.913; P =0.002), log (ALT) (OR: 6.186; P <0.001), Med-Diet adherence (intermediate vs. low OR: 0.115; P =0.041, high vs. low OR: 0.093; P =0.030), T2DM (OR: 3.940; P =0.003), and high waist circumference (OR: 3.012; P <0.001) were associated with NAFLD. Among single foods, low meat intake (OR: 0.178; P <0.001) was inversely significantly associated with NAFLD. In 334 non-diabetic NAFLD patients, age (OR: 1.035, P =0.025), high waist circumference (OR: 7.855, P <0.001), hypertriglyceridemia (OR: 2.152, P =0.011), and Log (ALT) (OR: 2.549, P =0.002) were directly associated with HOMA-IR, whereas Med-Diet score was inversely associated (OR: 0.801, P =0.018).

Conclusions:

We found an inverse relationship between Med-Diet and NAFLD prevalence. Among NAFLD patients, good adherence to Med-Diet was associated with lower insulin resistance. Our findings suggest that Med-Diet may be a beneficial nutritional approach in NAFLD patients.