The mediterranean diet as a nutritional intervention strategy for the treatment of non-alcoholic fatty liver disease: A literature review
DOI:
https://doi.org/10.62827/nb.v24i4.3080Keywords:
Mediterranean; Fatty Liver; Non-alcoholic Fatty Liver Disease.Abstract
Introduction: Contemporary lifestyle is associated with an increasing incidence of non-alcoholic fatty liver disease (NAFLD), in parallel with rising rates of obesity, insulin resistance and metabolic syndrome. In NAFLD, lipid accumulation in the liver results from a chronically positive energy balance and sedentary behavior without significant alcohol intake. The Western diet is linked to a higher risk of disease progression, whereas the Mediterranean dietary pattern, due to its nutritional composition, shows important potential for improvement. Objective: To synthesize evidence on the use of the Mediterranean diet in the treatment of NAFLD. Methods: Integrative literature review with searches in PubMed, the Virtual Health Library (BVS - Brazil) and the Cochrane Library, from 2013 to 2023, using the descriptors "Dieta Mediterrânea", "Hepatopatia Gordurosa Não Alcoólica", "Diet, Mediterranean", "Nutrition Therapy", "Non-alcoholic Fatty Liver Disease" e "Diet, Food, and Nutrition". Clinical trials, observational studies, and systematic reviews in English were included. Exclusion criteria: publications in other languages, studies with animals, and inadequate designs. Selection was performed by one reviewer. 813 articles were identified, and after duplications, 323 were screened, 50 evaluated, and 16 included. Data were extracted and synthesized using descriptive qualitative analysis. Results: The Mediterranean diet helps control risk factors, reduces the chances of progression, and increases the possibility of regression of non-alcoholic fatty liver disease. Greater adherence to the Mediterranean pattern was related to changes in biochemical and anthropometric parameters. Conclusion: The Mediterranean diet may be a valuable non-pharmacological approach to improve liver function and reduce the risk of progression of non-alcoholic fatty liver disease.
References
Younossi Z, Anstee MQ, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol [Internet]. 2018 Jan [cited 2026 Jan 21];15(1):11-20. Available from: https://pubmed.ncbi.nlm.nih.gov/28930295. doi:10.1038/nrgastro.2017.109
Worm N. Beyond body weight-loss: dietary strategies targeting intrahepatic fat in NAFLD. Nutrients [Internet]. 2020 May [cited 2026 Jan 21];12(5):1316. Available from: https://pubmed.ncbi.nlm.nih.gov/32384593. doi:10.3390/nu12051316
Kim D, Li AA, Gadiparthi C, Khan MA, Cholankeril G, Glenn JS, et al. Changing trends in etiology-based annual mortality from chronic liver disease, from 2007 through 2016. Gastroenterology [Internet]. 2018 Oct [cited 2026 Jan 21];155(4):1154-1163.e3. Available from: https://pubmed.ncbi.nlm.nih.gov/30009816. doi:10.1053/j.gastro.2018.07.008
Roeb E, Steffen HM, Bantel H, Baumann U, Canbay A, Demir M, et al. S2k guideline non-alcoholic fatty liver disease. Z Gastroenterol [Internet]. 2015 Jul [cited 2026 Jan 21];53(7):668-723. Available from: https://pubmed.ncbi.nlm.nih.gov/26167698. doi:10.1055/s-0035-1553193
Berná G, Romero-Gomez M. The role of nutrition in non-alcoholic fatty liver disease: pathophysiology and management. Liver Int [Internet]. 2020 Feb [cited 2026 Jan 21];40:102-8. Available from: https://pubmed.ncbi.nlm.nih.gov/32077594. doi:10.1111/liv.14360
Younossi Z, Tacke F, Arrese M, Sharma BC, Mostafa I, Bugianesi E, et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology [Internet]. 2019 Jun [cited 2026 Jan 21];69(6):2672-82. Available from: https://pubmed.ncbi.nlm.nih.gov/30179269. doi:10.1002/hep.30251
Abenavoli L, Boccuto L, Federico A, Dallio M, Loguercio C, Di Renzo L, et al. Diet and non-alcoholic fatty liver disease: the Mediterranean way. Int J Environ Res Public Health [Internet]. 2019 Aug [cited 2026 Jan 21];16(17):3011. Available from: https://pubmed.ncbi.nlm.nih.gov/31438482. doi:10.3390/ijerph16173011
Younossi ZM. Non-alcoholic fatty liver disease – a global public health perspective. J Hepatol [Internet]. 2019 Mar [cited 2026 Jan 21];70(3):531-44. Available from: https://pubmed.ncbi.nlm.nih.gov/30414863. doi:10.1016/j.jhep.2018.10.033
Perdomo CM, Frühbeck G, Escalada J. Impact of nutritional changes on nonalcoholic fatty liver disease. Nutrients [Internet]. 2019 Mar [cited 2026 Jan 21];11(3):677. Available from: https://pubmed.ncbi.nlm.nih.gov/30901929. doi:10.3390/nu11030677
Kirkevold M. Integrative nursing research: an important strategy to further the development of nursing science and nursing practice. J Adv Nurs [Internet]. 1997 May [cited 2026 Jan 21];25(5):977-84. Available from: https://pubmed.ncbi.nlm.nih.gov/9147203. doi:10.1046/j.1365-2648.1997.1997025977.x
Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein (São Paulo) [Internet]. 2010 Jan-May [cited 2026 Jan 21];8:102-6. Available from: https://doi.org/10.1590/S1679-45082010RW1134. doi:10.1590/S1679-45082010RW1134
Sousa LM; Marques-Vieira CM; Severino SP, Antunes AV. A metodologia de revisão integrativa da literatura em enfermagem. Rev Investig Enferm [Internet]. 2017 Nov [cited 2026 Jan 21];21(2):17-26. Available from: http://hdl.handle.net/20.500.12253/1311.
Ryan MC, Itsiopoulos C, Thodis T, Ward G, Trost N, Hofferberth S, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol [Internet]. 2013 Jul [cited 2026 Jan 21];59(1):138-43. Available from: https://pubmed.ncbi.nlm.nih.gov/23485520. doi:10.1016/j.jhep.2013.02.012
Kontogianni MD, Tileli N, Margariti A, Georgoulis M, Deutsch M, Tiniakos D, et al. Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease. Clin Nutr [Internet]. 2014 Aug [cited 2026 Jan 21];33(4):678-83. Available from: https://pubmed.ncbi.nlm.nih.gov/24064253. doi:10.1016/j.clnu.2013.08.014
Abenavoli L, Greco M, Milic N, Accattato F, Foti D, Gulletta E, et al. Effect of Mediterranean diet and antioxidant formulation in non-alcoholic fatty liver disease: a randomized study. Nutrients [Internet]. 2017 Aug [cited 2026 Jan 21];9(8):870. Available from: https://pubmed.ncbi.nlm.nih.gov/28805669. doi:10.3390/nu9080870
Montemayor S, Mascaró CM, Ugarriza L, Casares M, Llompart I, Abete I, et al. Adherence to Mediterranean diet and NAFLD in patients with metabolic syndrome: the FLIPAN study. Nutrients [Internet]. 2022 Aug [cited 2026 Jan 21];14(15):3186. Available from: https://pubmed.ncbi.nlm.nih.gov/35956364. doi:10.3390/nu14153186
Alferink LJ, Erler NS, Knegt RJ, Janssen HL, Metselaar HJ, Murad SD, et al. Adherence to a plant-based, high-fibre dietary pattern is related to regression of non-alcoholic fatty liver disease in an elderly population. Eur J Epidemiol [Internet]. 2020 Nov [cited 2026 Jan 21];35:1069-85. Available from: https://pubmed.ncbi.nlm.nih.gov/32323115. doi:10.1007/s10654-020-00627-2
Miryan M, Darbandi M, Moradi M, Najafi F, Soleimani D, Pasdar Y. Relationship between the Mediterranean diet and risk of hepatic fibrosis in patients with non-alcoholic fatty liver disease: a cross-sectional analysis of the RaNCD cohort. Front Nutr [Internet]. 2023 Feb [cited 2026 Jan 21];10:1062008. Available from: https://pubmed.ncbi.nlm.nih.gov/36908910. doi:10.3389/fnut.2023.1062008
Misciagna G, Díaz MD, Caramia DV, Bonfiglio C, Franco I, Noviello MR, et al. Effect of a low glycemic index Mediterranean diet on non-alcoholic fatty liver disease: a randomized controlled clinical trial. J Nutr Health Aging [Internet]. 2017 [cited 2026 Jan 21];21:404-12. Available from: https://pubmed.ncbi.nlm.nih.gov/28346567. doi:10.1007/s12603-016-0809-8
Katsagoni CN, Papatheodoridis GV, Ioannidou P, Deutsch M, Alexopoulou A, Papadopoulos N, et al. Improvements in clinical characteristics of patients with non-alcoholic fatty liver disease, after an intervention based on the Mediterranean lifestyle: a randomised controlled clinical trial. Br J Nutr [Internet]. 2018 Jul [cited 2026 Jan 21];120(2):164-75. Available from: https://pubmed.ncbi.nlm.nih.gov/29947322. doi:10.1017/S000711451800137X
Ristic-Medic D, Kovacic M, Takic M, Arsic A, Petrovic S, Paunovic M, et al. Calorie-restricted Mediterranean and low-fat diets affect fatty acid status in individuals with nonalcoholic fatty liver disease. Nutrients [Internet]. 2020 Dec [cited 2026 Jan 21];13(1):15. Available from: https://pubmed.ncbi.nlm.nih.gov/33374554. doi:10.3390/nu13010015
Akhlaghi M, Ghasemi-Nasab M, Riasatian M. Mediterranean diet for patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis of observational and clinical investigations. J Diabetes Metab Disord [Internet]. 2020 Feb [cited 2026 Jan 21];19:575-84. Available from: https://pubmed.ncbi.nlm.nih.gov/32550210. doi:10.1007/s40200-019-00475-2
Monserrat-Mesquida M, Quetglas-Llabrés M, Bouzas C, Montemayor S, Mascaró CM, Casares M, et al. Increased adherence to the Mediterranean diet after lifestyle intervention improves oxidative and inflammatory status in patients with non-alcoholic fatty liver disease. Antioxidants (Basel) [Internet]. 2022 Jul [cited 2026 Jan 21];11(8):1440. Available from: https://pubmed.ncbi.nlm.nih.gov/35892642. doi:10.3390/antiox11081440
Quetglas-Llabrés MM, Monserrat-Mesquida M, Bouzas C, Llompart I, Mateos D, Casares M, et al. Mediterranean diet improves plasma biomarkers related to oxidative stress and inflammatory process in patients with non-alcoholic fatty liver disease. Antioxidants (Basel) [Internet]. 2023 Mar [cited 2026 Jan 21];12(4):833. Available from: https://pubmed.ncbi.nlm.nih.gov/37107208. doi:10.3390/antiox12040833
Metro D, Buda M, Manasseri L, Corallo F, Cardile D, Buono VL, et al. Role of nutrition in the etiopathogenesis and prevention of nonalcoholic fatty liver disease (NAFLD) in a group of obese adults. Medicina (Kaunas) [Internet]. 2023 Mar [cited 2026 Jan 21];59(3):638. Available from: https://pubmed.ncbi.nlm.nih.gov/36984639. doi:10.3390/medicina59030638
Marin-Alejandre BA, Abete I, Cantero I, Monreal JI, Elorz M, Herrero JI, et al. The metabolic and hepatic impact of two personalized dietary strategies in subjects with obesity and nonalcoholic fatty liver disease: the fatty liver in obesity (FLiO) randomized controlled trial. Nutrients [Internet]. 2019 Oct [cited 2026 Jan 21];11(10):2543. Available from: https://pubmed.ncbi.nlm.nih.gov/31652512. doi:10.3390/nu11102543
Gepner Y, Shelef I, Komy O, Cohen N, Schwarzfuchs D, Bril N, et al. The beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content. J Hepatol [Internet]. 2019 Aug [cited 2026 Jan 21];71(2):379-88. Available from: https://pubmed.ncbi.nlm.nih.gov/31075323. doi:10.1016/j.jhep.2019.04.013
Franco I, Bianco A, Mirizzi A, Campanella A, Bonfiglio C, Sorino P, et al. Physical activity and low glycemic index Mediterranean diet: main and modification effects on NAFLD score. Results from a randomized clinical trial. Nutrients [Internet]. 2021 Dec [cited 2026 Jan 21];13(1):66. Available from: https://pubmed.ncbi.nlm.nih.gov/33379253. doi:10.3390/nu13010066
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