Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) comprises a wide spectrum of hepatic disorders, from simple steatosis to hepatic necro-inflammation leading to non-alcoholic steatohepatitis (NASH). Although the prevalence of these multifactorial pathologies is continuously increasing in the population, there is still not an established methodology for their treatment other than weight loss and a change in lifestyle habits, such as a hypocaloric diet and physical exercise. In this framework, there is increasing evidence that several food bioactives and dietary patterns are effective for reversing and preventing the onset of these pathologies. Some studies have claimed that better responses are obtained when treatments are performed under a multifaceted approach, using different bioactive compounds that act against complementary targets. Thus, in this work, current strategies for treating NAFLD and NASH based on multi-ingredient-based supplements or the Mediterranean diet, a dietary pattern rich in bioactive compounds, are reviewed. Furthermore, the usefulness of omics techniques to design effective multi-ingredient nutritional interventions and to predict and monitor their response against these disorders is also discussed.

Dietary Factors in Relation to Liver Fat Content: A Cross-sectional Study

“…The MED diet score inversely associated with liver fat content and NAFLD in the present study. This result is in line with findings from other observational studies [34] and with experimental data to suggest protection from excess liver fat accumulation due to the high anti-oxidant contents of the MED diet [12,13]. Interestingly, in a recent cross-sectional study that reported an inverse association between adherence to the MED diet and NAFLD, the statistical effect was attenuated by adjusting for BMI [35], and iso-caloric dietary interventions trials are of special interest.…”

ESPEN guideline on clinical nutrition in liver disease

“…Seven interventional [269e275] and five observational [276e280] studies are available suggesting that a Mediterranean diet (MEDD) has beneficial effects on body weight, insulin sensitivity and hepatic steatosis and fibrosis, but without clear evidence in respect of preventing the appearance of NAFLD [119,281,282]. There is, however, a solid body of clinical evidence supporting the beneficial effect of MEDD in terms of lowering the risk of cardiovascular disease and the development of diabetes, conditions that share common etiological factors with NAFLD, like insulin resistance and obesity [283].…”

Role of Overweight and Obesity in Gastrointestinal Disease

“…Indeed, it has been widely demonstrated that, the beneficial effects of the Mediterranean diet on NAFLD could be explained by both the promotion of weight loss and the provision of nutrients and bioactive compounds. Indeed, it has been demonstrated that polyphenols, vitamins, and terpenes, may display an anti-inflammatory effect in the liver thus leading to a reduction in the oxidative stress [76].…”