Effect of a Mediterranean Lifestyle Intervention on Biochemical and Clinical Characteristics of Patients With Non-alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is a pathologic condition which involves both hepatic steatosis and non alcoholic steatohepatitis (NASH), as the result of fat accumulation in the liver (liver fat >5-10% of liver weight), not due to excess alcohol consumption or other causes of steatosis. Its prevalence ranges in the general population from 10-35%, while in obese individuals can reach the 75% and is particularly worrying because these people appear to have a higher mortality from both liver and non-liver-related disease, such as cardiovascular disease, and therefore a greater economic burden of health costs.

At present, no medication or surgical procedure has been approved for treating NAFLD and lifestyle modifications remain the cornerstone therapy targeting both at weight reduction for overweight subjects and at prevention of overweight for the normal weight individuals. Given that a Mediterranean dietary pattern has a beneficial effect both on the prevention and the resolution of the metabolic syndrome, the main aim of the present study is to implement and evaluate the potential benefits of an intervention based on the Mediterranean lifestyle in a sample of patients with NAFLD. A secondary aim will be to produce material, for both health professionals (namely dietitians and doctors) and patients to help them implementing such an intervention based on the Mediterranean lifestyle.

This study will be a prospective, randomized, blinded and controlled study. Participants with NAFLD and BMI>25Kg/m2 (range 25-40 Kg/m2) will be included. NAFLD's diagnosis will be based on increased serum levels of alanine aminotransferase (ALT), with or without increased gamma-glutamyl transpeptidase (GGT) serum levels, the presence of hepatic steatosis and absence of other causes of hepatic steatosis and hepatic failure.

At baseline, patients will be informed about the study and will give their written consent. Then subjects will be randomly assigned to one of 3 groups: (a) Control group, receiving written general advice for a healthy lifestyle; (b) Mediterranean diet Group or (c) Mediterranean lifestyle group. Participants in (b) and (c) groups will attend a more comprehensive program, comprising seven 60-min group counseling sessions, conducted every two weeks for the first 2 months and every month for the following 4 months, until the 6-month evaluation. Participants will be also assessed 12 months after their entry in the study.

The dietary intervention and the monitoring will be carried out in the laboratory of Clinical Nutrition & Dietetics at Harokopio University, where experienced clinical dietitians will conduct all consultations. Counseling will be based on the goal setting theory. Motivational and behavioral strategies will be also used. In the Mediterranean diet group, all food groups of the Mediterranean diet will be targeted, whereas in the Mediterranean lifestyle group culinary practices, seasonality, and locality of food products, socialization during meals, rest during the day, as well as the adoption of an active living will be additionally addressed. Intervention will also aim at achieving a 5-10% weight loss within the first 6 months.