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

The American Journal of Gastroenterology volume 112, pages 18321839 (2017) | Download Citation



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.


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).


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).


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.

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We would like to thank nurse Daniela Salzano for her skillful collaboration.

Author information

Author notes

    • Francesco Baratta
    •  & Daniele Pastori

    These author contributed equally to this work


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

    • Francesco Baratta
    • , Daniele Pastori
    • , Licia Polimeni
    • , Cinzia Calabrese
    • , Francesco Violi
    •  & Maria Del Ben
  2. Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences—Sapienza University of Rome, Rome, Italy

    • Francesco Baratta
    •  & Daniele Pastori
  3. Department of Medical Specialties, Salerno University of Medicine, Salerno, Italy

    • Tommaso Bucci
  4. Department of Cellular Biotechnologies and Hematology, "La Sapienza" University, Policlinico Umberto I Hospital, Rome, Italy

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

    • Ilaria Ernesti
  6. Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy

    • Gaetano Pannitteri
  7. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

    • Francesco Angelico


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Competing interests

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.

Corresponding author

Correspondence to Daniele Pastori.

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