Effectiveness of the Mediterranean diet in an adult population with hepatic steatosis associated with metabolic dysfunction
Keywords:
fatty liver; mediterranean diet; metabolic syndrome; review literature as topic; vascular healthAbstract
Introduction: hepatic steatosis associated with metabolic dysfunction is one of the leading chronic conditions worldwide. In its nutritional treatment, the mediterranean diet is a pattern of particular interest.
Objective: to synthesize the scientific evidence on the effectiveness of the mediterranean diet in an adult population suffering from hepatic steatosis associated with metabolic dysfunction.
Methods: a systematic review of randomized and non-randomized clinical trials in adults with hepatic steatosis associated with metabolic dysfunction was carried out. The effectiveness of the mediterranean diet, its variants, and other diets was compared. Studies published between 2018 and 2025, in spanish and english, were selected from MEDLINE, PubMed, Scopus, EMBASE, and LILACS. The results of liver and cardiometabolic tests were taken into account. The risks of bias were assessed using the Cochrane risk-of-bias tool for randomized trials, and the Newcastle-Ottawa scale.
Results: 10 studies were analyzed (80.00 % randomized clinical trials). Participants were adults with hepatic steatosis, overweight or obesity; some had insulin resistance or metabolic syndrome. The standard mediterranean diet was compared with its variations, or other diets. In most patients, sustained improvements were observed in anthropometric indices, glucose, insulin resistance, and lipid profile.
Conclusions: the mediterranean diet and its variants consistently contribute to the improvement of hepatic steatosis associated with metabolic dysfunction in adults. This review synthesized the comparative scientific evidence on the subject, in an integrated reading of the results and methodological limitations of various investigations.
Downloads
References
1. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol [Internet]. 2020 [citado 23 Nov 2025];73(1):202-9. Disponible en: https://pure-oai.bham.ac.uk/ws/files/98025484/1_s2.0_S0168827820302014_main.pdf
2. Huh Y, Cho YJ, Nam GE. Recent epidemiology and risk factors of nonalcoholic fatty liver disease. J Obes Metab Syndr [Internet]. 2022 [citado 23 Nov 2025];31(1):17-27. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8987457/pdf/jomes-31-1-17.pdf
3. Duell PB, Welty FK, Miller M, Chait A, Hammond G, Ahmad Z, et al. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol [Internet]. 2022 [citado 23 Nov 2025];42(6):e168-85. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/ATV.0000000000000153?trk=public_post_comment-text
4. Eslam M, George J. Two years on, a perspective on MAFLD. Gastroenterology [Internet]. 2023 [citado 23 Nov 2025];1(2):e100019. Disponible en: https://egastroenterology.bmj.com/content/egastro/1/2/e100019.full.pdf
5. George ES, Reddy A, Nicoll AJ, Ryan MC, Itsiopoulos C, Abbott G, et al. Impact of a Mediterranean diet on hepatic and metabolic outcomes in non-alcoholic fatty liver disease: the MEDINA randomised controlled trial. Liver Int [Internet]. 2022 [citado 23 Nov 2025];42(6):1308-22. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9544144/pdf/LIV-42-1308.pdf
6. Properzi C, O'Sullivan TA, Sherriff JL, Ching HL, Jeffrey GP, Buckley RF, et al. Ad libitum Mediterranean and low-fat diets both significantly reduce hepatic steatosis: a randomized controlled trial. Hepatol [Internet]. 2018 [citado 23 Nov 2025];68(5):1741-54. Disponible en: https://onlinelibrary.wiley.com/doi/epdf/10.1002/hep.30076
7. Gepner Y, Shelef I, Schwarzfuchs D, Zelicha H, Tene L, Yaskolka Meir A, et al. Effect of distinct lifestyle interventions on mobilization of fat storage pools: CENTRAL magnetic resonance imaging randomized controlled trial. Circulat [Internet]. 2018 [citado 23 Nov 2025];137(11):1143-57. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.117.030501
8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ [Internet]. 2021 [citado 23 Nov 2025];372(71):[aprox. 9 p.]. Disponible en: https://www.bmj.com/content/bmj/372/bmj.n71.full.pdf
9. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ [Internet]. 2019 [citado 23 Nov 2025];366:l4898. Disponible en: https://www.bmj.com/content/bmj/366/bmj.l4898.full.pdf
10. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute [Internet]. 2011 [citado 23 Nov 2025];2(1):[aprox. 12 p.]. Disponible en: https://www3.med.unipmn.it/dispense_ebm/2009-2010/Corso%20Perfezionamento%20EBM_Faggiano/NOS_oxford.pdf
11. Tsitsou S, Bali T, Adamantou M, Saridaki A, Poulia K, Karagiannakis DS, et al. Effects of a 12-week Mediterranean-type time-restricted feeding protocol in patients with metabolic dysfunction-associated steatotic liver disease: a randomised controlled trial – the “CHRONO-NAFLD Project”. Aliment Pharmacol Ther [Internet]. 2025 [citado 23 Nov 2025];61(8):1290-309. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11950810/pdf/APT-61-1290.pdf
12. Zanini B, Benini F, Marullo M, Simonetto A, Rossi A, Cavagnoli P, et al. Mediterranean-oriented dietary intervention is effective to reduce liver steatosis in patients with nonalcoholic fatty liver disease: results from an Italian clinical trial. Int J Clin Pract [Internet]. 2024 [citado 23 Nov 2025];2024:8861126. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10834092/pdf/IJCLP2024-8861126.pdf
13. 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 [citado 23 Nov 2025];71(2):379-88. Disponible en: https://www.journal-of-hepatology.eu/action/showPdf?pii=S0168-8278%2819%2930274-0
14. Kestane VU, Bas M. Efficacy of the Mediterranean diet containing different macronutrients on non-alcoholic fatty liver disease. Nutrients [Internet]. 2024 [citado 23 Nov 2025];16(16):2699. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11357554/pdf/nutrients-16-02699.pdf
15. Meir AY, Rinott E, Tsaban G, Zelicha H, Kaplan A, Rosen P, et al. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Gut [Internet]. 2021 [citado 23 Nov 2025];70(11):2085-95. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8515100/pdf/gutjnl-2020-323106.pdf
16. Monserrat-Mesquida M, Bouzas C, García S, Mateos D, Casares M, Ugarriza L, et al. Two-year Mediterranean diet intervention improves hepatic health in MASLD patients. Foods [Internet]. 2025 [citado 23 Nov 2025];14(10):1736. Disponible en: https://www.researchgate.net/profile/Margalida-Monserrat-Mesquida/publication/391758100_Two-Year_Mediterranean_Diet_Intervention_Improves_Hepatic_Health_in_MASLD_Patients/links/683427cbdf0e3f544f59cad2/Two-Year-Mediterranean-Diet-Intervention-Improves-Hepatic-Health-in-MASLD-Patients.pdf
17. Dogay-Us G, Innocenti F, Koc OM, Alagoz AE, Yumuk VD, Gungor ZB, et al. Mediterranean and low-fat diets are equally effective in MASLD resolution at 12 weeks regardless of PNPLA3 genotype: a randomized controlled trial. Hepatol Commun [Internet]. 2025 [citado 23 Nov 2025];9(12):e0856. Disponible en: https://journals.lww.com/hepcomm/fulltext/2025/12010/mediterranean_and_low_fat_diets_are_equally.13.aspx
18. 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]. 2021 [citado 23 Nov 2025];13(1):15. Disponible en: https://www.mdpi.com/2072-6643/13/1/15
19. Yu D, Yu P, Huang W, Zhang P, Li L. A network meta-analysis of the clinical efficacy of different dietary patterns in the treatment of adult metabolic dysfunction-associated steatotic liver diseases. Clin Nut Open Sci [Internet]. 2025 [citado 23 Nov 2025];64:357-76. Disponible en: https://www.clinicalnutritionopenscience.com/article/S2667-2685(25)00126-3/pdf
20. Haigh L, Kirk C, Gendy KE, Gallacher J, Errington L, Mathers JC, et al. The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis. Clin Nutr [Internet]. 2022 [citado 23 Nov 2025];41(9):1913-31. Disponible en: https://www.clinicalnutritionjournal.com/action/showPdf?pii=S0261-5614%2822%2900231-X
21. 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 [citado 23 Nov 2025];14(15):3186. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9370227/pdf/nutrients-14-03186.pdf
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Adan Alexander Solano Salazar
This work is licensed under a Creative Commons Attribution 4.0 International License.
Those authors who have publications with this journal accept the following terms of the License CC Attribution-NonCommercial 4.0 International (CC BY-NC 4.0):
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
The journal is not responsible for the opinions and concepts expressed in the works, which are the exclusive responsibility of the authors. The Editor, with the assistance of the Editorial Committee, reserves the right to suggest or request advisable or necessary modifications. Original scientific works are accepted for publication, as are the results of research of interest that have not been published or sent to another journal for the same purpose.
The mention of trademarks of specific equipment, instruments or materials is for identification purposes, and there is no promotional commitment in relation to them, neither by the authors nor by the editor.
