Two-Year Mediterranean Diet Intervention Improves Hepatic Health in MASLD Patients

Abstract

[eng] Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)is one of the leading causes of chronic liver disease, affecting 30% of the global adultpopulation and continuing to rise. Objective: We aimed to assess the effect of a twoyearfollow-up Mediterranean diet intervention on parameters of liver health in MASLDpatients. Methods: Sixty-two people between 40 and 60 years of age, all diagnosed withMASLD, were enrolled in the two-year clinical trial, who were randomly assigned to one ofthree interventions following the Mediterranean diet pattern and the promotion of physicalactivity. After the intervention, the participants were categorized into two groups accordingto their progress in adhering to the Mediterranean diet (MedDiet), which was assessedat four follow-up time points, conducted at the start of this study and after 6, 12, and24 months of intervention. A multivariate general linear model adjusted for age, sex, andintervention (diet and physical activity) was used. Bonferroni’s post hoc test identifieddifferences between groups and sessions within the same group. Results: Participants inthe highly adherent group showed significantly stronger improvement in anthropometricmeasures, lipid profile, and liver enzyme levels during the follow-up period, along with areduction in the Dietary Inflammatory Index, intrahepatic fat content, the fatty liver index,and plasma cytokeratin-18 levels compared to baseline. The progress observed in severalparameters at 12 months came to a standstill, likely because of the COVID-19 pandemic atthat time. At 24 months, following the COVID-19 pandemic, these parameters improved asa result of better adherence to the Mediterranean diet. Conclusions: Greater adherence tothe Mediterranean diet, along with increased physical activity, significantly enhances liverhealth markers in individuals with MASLD. These findings support the Mediterraneanlifestyle as an effective non-pharmacological strategy to improve liver health and preventliver-related complications in MASLD patients, potentially reducing the future publichealth burden.