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  62th Annual Meeting of the American Association for the Study of Liver Diseases San Francisco 2011 Nov 6-9 Back grey_arrow_rt.gif
Fatty Liver May Benefit from Mediterranean Diet
  By Michael Smith, North American Correspondent, MedPage Today

Published: November 11, 2011

SAN FRANCISCO - The so-called Mediterranean diet may be a way to treat non-alcoholic hepatic steatosis or fatty liver disease, a researcher said here.

In a small, randomized crossover trial, patients on the Mediterranean diet reduced hepatic fat and increased insulin sensitivity, according to Marno Ryan, MD, of St. Vincent's Hospital in Melbourne, Australia.

In contrast, those on a standard low-fat diet that was rich in carbohydrates saw neither effect, Ryan said at the annual meeting of the American Association for the Study of Liver Diseases.

Action Points

· Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

· Explain that a small study found increased insulin sensitivity and decreased hepatic fat in patients with non-alcoholic fatty liver disease when they consumed a Mediterranean diet, but not when they consumed a standard low-fat diet.

· Note that the beneficial effects were seen in the absence of weight loss, which was similar between diets.

The findings were independent of weight loss and have "significant implications for patient care," Ryan said. "We can now offer patients evidence-based dietary advice that will reduce their risk of diabetes and liver disease even without weight loss."

But she cautioned that the study was small -- just 12 patients with biopsy-confirmed fatty liver -- and needs verification in a larger group.

Indeed, the study is "interesting and warrants further study," according to AASLD president Jake Liang, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Md.

"If we can prevent or treat a disease with diet," he told reporters, "that's probably better than drugs."

Liang said that fatty liver is "the disease of the 20th century" but luckily is usually benign, although it can lead to cirrhosis. On the other hand, the increase in obesity may mean rising levels of fatty liver, he added.

Ryan said study of the effects of diet on the condition has been lacking. To try to fill the gap, she and colleagues recruited 12 non-diabetic patients with fatty liver, with fibrosis no higher than stage F3, who drank less than two standard drinks of alcohol a day.

They were randomly assigned to either a standard low-fat, high-carbohydrate diet or to the Mediterranean diet, which is rich in mono-unsaturated fatty acids, N3 polyunsaturated fatty acids, folate, and fiber, but is low in saturated fats.

After six weeks, the participants had a six-week washout period, during which they ate their normal diet, followed by six weeks of the opposite dietary assignment.

The primary endpoints were change in insulin sensitivity, measured by three-hour hyperinsulinemic euglycemic clamp, and change in hepatic steatosis, measured by magnetic resonance imaging and spectroscopy.

Ryan reported that as a proportion of energy intake:

· Protein rose compared with baseline when participants were on the low-fat diet and fell when they were on the Mediterranean diet. Both differences were significant at P<0.01

· Carbohydrate intake rose significantly (at P<0.01) when participants were on the low-fat diet, but did not change significantly on the Mediterranean diet

· Fat intake fell on the low-fat diet and rose on the Mediterranean diet -- again, both differences were significant at P<0.01

· And there was a significant rise in fiber intake on the Mediterranean diet (at P<0.01) but no change on the low-fat diet

But the central finding, she said, was that both liver fat and insulin sensitivity improved on the Mediterranean diet, with little change on the low-fat diet, after controlling for weight loss, which was similar on both diets.

Specifically, she said, hepatic fat fell 39% from baseline when participants were eating the Mediterranean diet -- significant at P=0.012 -- but there was no significant change with the low-fat diet.

There was also improvement in insulin sensitivity with the Mediterranean diet (from a baseline average of 2.7 milligrams per kilogram per minute to 3.7), which was significant at P=0.05. There was no significant change after the low-fat diet, she said.

Ryan did not report any external support for the study. She said she had no disclosures.

Liang had no disclosures.

Primary source: Hepatology
Source reference:
Ryan MC, et al "The Mediterranean diet: improvement in hepatic steatosis and insulin sensitivity in individuals with NAFLD" Hepatology 2011; 54(4): Abstract 212.