Mediterranean diet is inversely associated with steatosis and fibrosis and decreases ten-year diabetes and cardiovascular risk in NAFLD subjects: Results from the ATTICA prospective cohort study

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 40; no. 5; pp. 3314 - 3324
• Main Authors: Kouvari, M., Boutari, C., Chrysohoou, C., Fragkopoulou, E., Antonopoulou, S., Tousoulis, D., Pitsavos, C., Panagiotakos, D.B., Mantzoros, C.S.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.05.2021
• Subjects: Adipocytokines; adiponectin; cardiovascular diseases; clinical nutrition; cohort studies; confidence interval; diabetes; fatty liver; fibrosis; Greece; Liver fibrosis; Liver steatosis; Macronutrients; Mediterranean diet; men; Nutrition; observational studies; odds ratio; prediction; risk; women; Greece; Adipocytokines; Macronutrients; Liver fibrosis; Nutrition; Liver steatosis
• ISSN: 0261-5614; 1532-1983; 1532-1983
• DOI: 10.1016/j.clnu.2020.10.058

We assessed the association of Mediterranean diet with NAFLD and their interaction in predicting ten-year diabetes onset and first fatal/non-fatal cardiovascular disease (CVD) incidence. The ATTICA prospective observational study in Athens, Greece included 1,514 men and 1,528 women (>18 years old) free-of-CVD at baseline. Liver steatosis and fibrosis indices were calculated. Mediterranean diet adherence was assessed through MedDietScore. At the ten-year follow-up visit, CVD evaluation was performed in an a priori specified subgroup of n = 2,020 participants and diabetes onset in n = 1,485 free-of-diabetes participants. MedDietScore was inversely associated with steatosis and fibrosis; e.g. in the case of the TyG index the Odds Ratio (OR) of the 3rd vs. 1st MedDietScore tertile was = 0·53, [95% Confidence Interval (95% CI) (0·29, 0·95)] and the associations persisted in multi-adjusted models. NAFLD predicted incident diabetes prospectively over a ten year period [HR = 1·87, 95% CI (0·75, 4·61)] and the association remained significant only in subjects with low MedDietScore (below median) whereas diabetes onset among subjects with higher MedDietScore was not influenced by NAFLD. Similarly, NAFLD predicted CVD [Hazard Ratio (HR) = 3·01, 95%CI(2·28, 3·95)]; the effect remained significant only in subjects with MedDietScore below median [HR = 1·38, 95% CI (1·00, 1·93)] whereas it was essentially null [HR = 1·00,95% CI (0·38, 2·63)] among subjects with higher score. Mediation analysis revealed that adiponectin and adiponectin-to-leptin ratio were the strongest mediators. We report an inverse association between Mediterranean diet and NAFLD. Mediterranean diet protected against diabetes and CVD prospectively among subjects with NAFLD.