Baratta Francesco, Pastori Daniele, Polimeni Licia, Bucci Tommaso, Ceci Fabrizio, Calabrese Cinzia, Ernesti Ilaria, Pannitteri Gaetano, Violi Francesco, Angelico Francesco, Del Ben Maria
I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences-Sapienza University of Rome, Rome, Italy.
Am J Gastroenterol. 2017 Dec;112(12):1832-1839. doi: 10.1038/ajg.2017.371. Epub 2017 Oct 24.
The prevalence of cardiometabolic disorders, including non-alcoholic fatty liver disease (NAFLD), is increasing in western countries, because of changes in lifestyle and dietary habits. Mediterranean Diet (Med-Diet) is effective for cardiovascular prevention, but its relationship with NAFLD has been scarcely investigated.
We included 584 consecutive outpatients presenting with one or more cardiovascular risk factor such as type 2 diabetes mellitus (T2DM), arterial hypertension, overweight/obesity, and dyslipidemia. Liver steatosis was assessed using ultrasonography. Med-Diet adherence was investigated by a validated semiquantitative nine-item dietary questionnaire; patients were divided into low, intermediate, and high adherence. Insulin resistance was defined by the 75th percentile of homeostasis model of insulin resistance (HOMA-IR; ≥3.8).
The mean age was 56.2±12.4 years and 38.2% were women. Liver steatosis was present in 82.7%, and its prevalence decreased from low to high adherence group (96.5% vs. 71.4%, P<0.001). In a multiple logistic regression analysis, hypertriglyceridemia (odds ratio (OR): 2.913; P=0.002), log (ALT) (OR: 6.186; P<0.001), Med-Diet adherence (intermediate vs. low OR: 0.115; P=0.041, high vs. low OR: 0.093; P=0.030), T2DM (OR: 3.940; P=0.003), and high waist circumference (OR: 3.012; P<0.001) were associated with NAFLD. Among single foods, low meat intake (OR: 0.178; P<0.001) was inversely significantly associated with NAFLD. In 334 non-diabetic NAFLD patients, age (OR: 1.035, P=0.025), high waist circumference (OR: 7.855, P<0.001), hypertriglyceridemia (OR: 2.152, P=0.011), and Log (ALT) (OR: 2.549, P=0.002) were directly associated with HOMA-IR, whereas Med-Diet score was inversely associated (OR: 0.801, P=0.018).
We found an inverse relationship between Med-Diet and NAFLD prevalence. Among NAFLD patients, good adherence to Med-Diet was associated with lower insulin resistance. Our findings suggest that Med-Diet may be a beneficial nutritional approach in NAFLD patients.
由于生活方式和饮食习惯的改变，包括非酒精性脂肪性肝病（NAFLD）在内的心脏代谢紊乱在西方国家的患病率正在上升。地中海饮食（Med-Diet）对心血管疾病有预防作用，但其与NAFLD的关系鲜有研究。
我们纳入了584例连续门诊患者，这些患者存在一种或多种心血管危险因素，如2型糖尿病（T2DM）、动脉高血压、超重/肥胖和血脂异常。采用超声评估肝脏脂肪变性。通过一份经过验证的半定量九项饮食问卷调查Med-Diet依从性；将患者分为低、中、高依从性组。胰岛素抵抗通过胰岛素抵抗稳态模型（HOMA-IR）的第75百分位数定义（≥3.8）。
平均年龄为56.2±12.4岁，女性占38.2%。82.7%的患者存在肝脏脂肪变性，其患病率从低依从性组到高依从性组逐渐降低（96.5%对71.4%，P<0.001）。在多因素逻辑回归分析中，高甘油三酯血症（比值比（OR）：2.913；P=0.002）、log（ALT）（OR：6.186；P<0.001）、Med-Diet依从性（中对低OR：0.115；P=0.041，高对低OR：0.093；P=0.030）、T2DM（OR：3.940；P=0.003）和高腰围（OR：3.012；P<0.001）与NAFLD相关。在单一食物中，低肉类摄入量（OR：0.178；P<0.001）与NAFLD呈显著负相关。在334例非糖尿病NAFLD患者中，年龄（OR：1.035，P=0.025）、高腰围（OR：7.855，P<0.001）、高甘油三酯血症（OR：2.152，P=0.011）和Log（ALT）（OR：2.549，P=0.002）与HOMA-IR呈正相关，而Med-Diet评分与HOMA-IR呈负相关（OR：0.801，P=0.018）。
我们发现Med-Diet与NAFLD患病率之间存在负相关。在NAFLD患者中，良好的Med-Diet依从性与较低的胰岛素抵抗相关。我们的研究结果表明，Med-Diet可能是NAFLD患者有益的营养方法。
