While the health benefits of the Mediterranean (MED) diet have been well established in previous studies, new research looked at a further restrictive “green-Mediterranean diet” to help patients with non-alcoholic fatty liver disease (NAFLD). 

The DIRECT-PLUS 18-month randomized trial included nearly 300 patients with abdominal obesity or dyslipidemia into one of three groups, healthy dietary guidelines, MED, and green-MED weight-loss diet. Patients in all three groups were given a physical exercise regimen as well. 

According to results published in Gut, patients in both MED groups were given 28 g/d of walnuts, the green group was also assigned to consume 3-4 cups of green tea per day and a Mankai green shake. 

The authors noted that overall NAFLD prevalence declined by 54.8% in the healthy diet group, 47.9% in the MED group, and 31.5% in the green-MED arm. 

While there were similar weight loss findings between the two MED groups, patients in the green-MED group had almost double the intrahepatic fat loss compared to the MED and healthy diet groups. 

They found that greater IHF% loss was associated with several factors, including increased Mankai and walnuts intake, and decreased consumption of red and processed meats. 

After 18 months, the authors noted that patients in both MED groups had significantly higher total plasma polyphenol levels compared to the healthy diet group.

The researchers noted several limitations of the study, including a higher proportion of male participants, which they said is particularly limiting considering NAFLD is “almost as prevalent in women.”

They also said the results might not extend to people who aren’t abdominally obese or have dyslipidemia or a population with a lower prevalence of NAFLD. 

“Following our previous trials suggesting that the MED diet is favorable to a low-fat diet in terms of cardiometabolic risk and IHF loss, this clinical trial may suggest an effective nutritional tool for the treatment of NAFLD beyond weight loss, a predicament that very little, if any effect, pharmacological treatment exists for,” Anat Yaskolka Meir, Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel and colleagues wrote.


By Adam Hochron