Diet and Non-Alcoholic Fatty Liver Disease: The Mediterranean Way

Lifestyle interventions remain the first-line treatment for non-alcoholic fatty liver disease (NAFLD), even if the optimal alimentary regimen is still controversial. The interest in antioxidants has increased over time, and literature reports an inverse association between nutrients rich in antioxidants and the risk of mortality due to non-communicable diseases, including NAFLD. Mediterranean diet (MD) is a model characterized by main consumption of plant-based foods and fish and reduced consumption of meat and dairy products. MD represents the gold standard in preventive medicine, probably due to the harmonic combination of many foods with antioxidant and anti-inflammatory properties. This regimen contributes substantially to the reduction of the onset of many chronic diseases as cardiovascular diseases, hypertension, type 2 diabetes mellitus, obesity, cancer, and NAFLD. The present review aims to clarify the intake of antioxidants typical of the MD and evaluate their effect on NAFLD.

• Publication year

  2019

• Venue

  International Journal of Environmental Research and Public Health

• Publication date

  2019-08-21

• Fields of study

  Medicine, Environmental Science

• Identifiers
  DOI 10.3390/ijerph16173011PMID 31438482PMCID 6747511
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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  2018cited by this paper
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  2018cited by this paper
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  2018cited by this paper
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  2018cited by this paper
• A Multi-strain Probiotic Reduces the Fatty Liver Index, Cytokines and Aminotransferase levels in NAFLD Patients: Evidence from a Randomized Clinical Trial.

  2018cited by this paper
• Consensus document. Management of non-alcoholic fatty liver disease (NAFLD). Clinical practice guideline.

  2018cited by this paper
• Genetics and epigenetics of NAFLD and NASH: Clinical impact.

  2018influential reference
• Pathogenesis of NASH: the Impact of Multiple Pathways

  2018cited by this paper
• Oxidative stress, aging, and diseases

  2018cited by this paper
• The Effects of Physical Exercise on Fatty Liver Disease.

  2018cited by this paper
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  2018cited by this paper
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  2018cited by this paper
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  2018cited by this paper
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  2017cited by this paper
• Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease

  2017cited by this paper
• Mediterranean meal versus Western meal effects on postprandial ox-LDL, oxidative and inflammatory gene expression in healthy subjects: a randomized controlled trial for nutrigenomic approach in cardiometabolic risk

  2017cited by this paper
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  2017cited by this paper
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  2017cited by this paper
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  2017cited by this paper
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  2017cited by this paper
• Dietary Composition Independent of Weight Loss in the Management of Non-Alcoholic Fatty Liver Disease

  2017cited by this paper
• AISF position paper on nonalcoholic fatty liver disease (NAFLD): Updates and future directions.

  2017cited by this paper
• Genetic and Epigenetic Profile of Patients With Alcoholic Liver Disease.

  2017cited by this paper
• Effect of Mediterranean Diet and Antioxidant Formulation in Non-Alcoholic Fatty Liver Disease: A Randomized Study

  2017cited by this paper
• Antioxidant Effects of a Hydroxytyrosol-Based Pharmaceutical Formulation on Body Composition, Metabolic State, and Gene Expression: A Randomized Double-Blinded, Placebo-Controlled Crossover Trial

  2017cited by this paper
• Non-alcoholic Fatty Liver Disease: A Clinical Update

  2017influential reference
• Genetic and Epigenetic Profile of Patients With Alcoholic Liver Disease.

  2017cited by this paper
• Post-prandial effects of hazelnut-enriched high fat meal on LDL oxidative status, oxidative and inflammatory gene expression of healthy subjects: a randomized trial.

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• Polyphenols: Extraction Methods, Antioxidative Action, Bioavailability and Anticarcinogenic Effects

  2016cited by this paper
• Impact of Mediterranean diet on metabolic syndrome, cancer and longevity

  2016cited by this paper
• Food Antioxidants and Their Anti-Inflammatory Properties: A Potential Role in Cardiovascular Diseases and Cancer Prevention

  2016cited by this paper
• Metabolic aspects of adult patients with nonalcoholic fatty liver disease.

  2016influential reference
• Action mechanism and cardiovascular effect of anthocyanins: a systematic review of animal and human studies

  2016cited by this paper
• Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review

  2016cited by this paper
• New obesity classification criteria as a tool for bariatric surgery indication.

  2016cited by this paper
• Extrahepatic Manifestations of Nonalcoholic Fatty Liver Disease

  2016cited by this paper
• EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease

  2016cited by this paper
• EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease.

  2016cited by this paper
• Food safety and nutritional quality for the prevention of non communicable diseases: the Nutrient, hazard Analysis and Critical Control Point process (NACCP)

  2015cited by this paper
• Nutritional Modulation of Non-Alcoholic Fatty Liver Disease and Insulin Resistance

  2015cited by this paper
• Definition of the Mediterranean Diet: A Literature Review

  2015cited by this paper
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  2015cited by this paper
• Definitions and potential health benefits of the Mediterranean diet: views from experts around the world

  2014cited by this paper
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  2013cited by this paper
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  2013cited by this paper
• A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.

  2012cited by this paper
• The association of the Mediterranean Adequacy Index with fatal coronary events in an Italian middle-aged male population followed for 40 years.

  2012cited by this paper
• Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases.

  2012cited by this paper
• The effects of Italian Mediterranean organic diet (IMOD) on health status.

  2010cited by this paper
• The Mediterranean Adequacy Index: further confirming results of validity.

  2009cited by this paper
• Is antioxidant plasma status in humans a consequence of the antioxidant food content influence?

  2007cited by this paper
• Mediterranean Adequacy Index of Italian diets

  2004cited by this paper
• Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study.

  1995cited by this paper
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  1991cited by this paper

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  2022cites this paper
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  2021cites this paper
• Association between Dietary Patterns and Non-alcoholic Fatty Liver Disease: Results from a Case-Control Study.

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  2020cites this paper
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  2020cites this paper
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  2020cites this paper
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  2020cites this paper
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  2020cites this paper
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  2020cites this paper
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  2020cites this paper