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Mediterranean diet reduces BMI and triglycerides in patients with NAFLD and MASLDMediterranean diet shows modest benefits for fatty liver disease

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Key Takeaway
Note that the Mediterranean diet provides modest improvements in BMI and triglycerides in NAFLD/MASLD patients.

This meta-analysis evaluated the impact of the Mediterranean diet compared to control diets in 980 patients with non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD). The analysis focused on various metabolic, hepatic, and anthropometric outcomes to determine the efficacy of the dietary intervention.

The analysis reported significant reductions in body mass index (SMD -0.43; 95% CI -0.84 to -0.02; p = 0.04) and triglycerides (SMD -0.50; 95% CI -0.88 to -0.12; p = 0.01). However, no statistically significant differences were observed for several other outcomes, including body weight, waist circumference, HOMA-IR, fasting insulin, HbA1c, lipid fractions, liver enzymes, and blood pressure.

Several limitations were noted, including moderate to high heterogeneity across outcomes (I up to 94%), lack of standardized dietary definitions in some trials, and short follow-up periods. Most outcomes were graded as low to very low certainty. While the Mediterranean diet showed modest improvements in BMI and triglycerides, it did not demonstrate clear superiority over comparator diets for most other metabolic or hepatic outcomes. Clinical application should be interpreted with caution due to the low certainty of evidence for most outcomes.

How this fits prior evidence

This meta-analysis addresses a gap in clinical management by evaluating dietary interventions for NAFLD and MASLD. It complements findings regarding lipid profiles, such as the preclinical evidence showing 6-gingerol improves hepatic lipid profiles and glucose metabolism in animal models of NAFLD. While the Mediterranean diet shows modest improvements in BMI and triglycerides, it does not provide a clear superior alternative for most metabolic outcomes compared to other diets.

Living with fatty liver disease, or MASLD, often involves managing many different health markers at once. A large review of data from 980 patients looked at how a Mediterranean diet compares to other diets for those with this condition. The goal was to see if this specific way of eating could improve overall health and liver function.

The findings show that the Mediterranean diet led to a modest reduction in body mass index and a significant drop in triglycerides, which are a type of fat in the blood. However, the diet did not show a clear advantage over other diets when it came to other important markers like blood pressure, liver enzymes, or blood sugar levels.

It is important to keep these results in perspective. Because many of the studies involved short follow-up periods and lacked standard definitions for what a Mediterranean diet actually included, the evidence for most outcomes is considered low to very low certainty. While the diet helped with weight and fats, it did not show clear superiority over other diets for most metabolic goals.

What this means for you:
The Mediterranean diet lowers body mass index and triglycerides in people with fatty liver disease.

Common questions

Does the Mediterranean diet help with fatty liver disease?

The Mediterranean diet showed modest improvements in body mass index and a significant reduction in triglycerides for patients with fatty liver disease. However, it did not show a clear advantage over other diets for most other metabolic or liver-related markers.

What specific health markers improved with this diet?

In a study of 980 patients, the Mediterranean diet led to a significant reduction in triglycerides and a significant reduction in body mass index. Other factors, such as blood pressure, liver enzymes, and blood sugar levels, did not show a statistically significant difference.

How certain are these results?

The evidence for most outcomes in this study was graded as low to very low certainty. This is because some trials had short follow-up periods and lacked standard definitions for the Mediterranean diet, making it hard to confirm its superiority over other diets.

Study Details

Study typeMeta analysis
Sample sizen = 980
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Non-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic dysfunction associated steatotic liver disease (MASLD), is the most prevalent chronic liver disorder worldwide and is strongly associated with obesity, insulin resistance, and cardiometabolic risk. The Mediterranean diet has been proposed as a therapeutic strategy for improving metabolic and hepatic outcomes. We hypothesized that adherence to the Mediterranean diet would improve anthropometric, metabolic, and hepatic outcomes compared with control diets in patients with NAFLD/MASLD. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted through February 2024. Twenty-three randomized controlled trials (RCTs) were included in the qualitative synthesis, of which 11 trials involving 980 participants contributed to the meta-analysis. Pooled standardized mean differences (SMD) with 95% confidence intervals were calculated using random-effects models. Compared with control diets, the Mediterranean diet was associated with significant reductions in body mass index (SMD -0.43; 95% CI -0.84 to -0.02; p = 0.04) and triglycerides (SMD -0.50; 95% CI -0.88 to -0.12; p = 0.01). No statistically significant differences were observed for body weight, waist circumference, HOMA-IR, fasting insulin, HbA1c, lipid fractions, liver enzymes, or blood pressure. Heterogeneity was moderate to high across several outcomes (I up to 94%), and most outcomes were graded as low to very low certainty. Overall, the Mediterranean diet produced modest improvements in BMI and triglycerides but did not demonstrate clear superiority over comparator diets for most metabolic or hepatic outcomes. Larger, high-quality randomized trials with standardized dietary definitions and longer follow-up are required to clarify its therapeutic role in NAFLD/MASLD.
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