Cueto-Galán Raquel, Fontalba-Navas Andres, Gutiérrez-Bedmar Mario, Ruiz-Canela Miguel, Martínez-González Miguel A, Alves Lilian, Babio Nancy, Fitó Montserrat, Ros Emilio, Fiol Miquel, Estruch Ramón, Arós Fernando, Serra-Majem Luis, Pintó Xavier, Muñoz-Bravo Carlos, García-Rodríguez Antonio, Gómez-Gracia Enrique
Department of Public Health and Psychiatry, School of Medicine, University of Málaga, Málaga, Spain.
Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.
Front Nutr. 2025 May 21;12:1518082. doi: 10.3389/fnut.2025.1518082. eCollection 2025.
Little is known about the potential preventive effect of adherence to the Mediterranean diet (MedDiet) on the development of metabolic dysfunction-associated steatotic liver disease (MASLD).
This study aims to determine the impact of adherence to the MedDiet on the progression of MASLD, measured using the hepatic steatosis index (HSI) at baseline and annually over a 5-year follow-up period within the framework of the (PREDIMED) study.
Participants from the PREDIMED trial with sufficient available data ( = 3,145) were examined annually over 5 years. Adherence to the MedDiet was evaluated using the Mediterranean Diet Adherence Screener (MEDAS) questionnaire, and the presence/severity of hepatic steatosis was determined according to the HSI. Linear mixed models were used to analyze the association between the study variables and HSI.
The participants (57% female, 43% male) had a mean age of 67.2 (SD 6.2) years. Among the cardiovascular risk factors considered, the mean BMI was 29.81 (SD 3.62); 47% of participants had type 2 diabetes, 70% had hypercholesterolaemia, and 84% had hypertension. Over the 5-year follow-up, average adherence to the MedDiet and physical activity generally increased, while alcohol consumption, calorie intake, tobacco use, hypercholesterolaemia, and hypertension decreased. The fully adjusted multivariate model reflected a statistically significant decrease in the HSI per unit increase in adherence to the MedDiet (β = -0.075; 95% CI: -0.128, -0.021).
In individuals at high cardiovascular risk, adherence to the MedDiet is significantly associated with improvements in HSI. These longitudinal findings highlight the important role of the MedDiet in delaying or slowing the natural progression of MASLD, contributing to both its prevention and clinical management.
关于坚持地中海饮食（MedDiet）对代谢功能障碍相关脂肪性肝病（MASLD）发展的潜在预防作用知之甚少。
本研究旨在确定在预防地中海饮食研究（PREDIMED）框架内，坚持MedDiet对MASLD进展的影响，通过在基线时以及在5年随访期内每年使用肝脏脂肪变性指数（HSI）进行测量。
对PREDIMED试验中有足够可用数据（n = 3145）的参与者进行了5年的年度检查。使用地中海饮食依从性筛查问卷（MEDAS）评估对MedDiet的依从性，并根据HSI确定肝脂肪变性的存在/严重程度。使用线性混合模型分析研究变量与HSI之间的关联。
参与者（57%为女性，43%为男性）的平均年龄为67.2（标准差6.2）岁。在所考虑的心血管危险因素中，平均体重指数为29.81（标准差3.62）；47%的参与者患有2型糖尿病，70%患有高胆固醇血症，84%患有高血压。在5年的随访中，对MedDiet的平均依从性和身体活动总体上有所增加，而酒精消费、卡路里摄入、烟草使用、高胆固醇血症和高血压则有所下降。完全调整后的多变量模型显示，MedDiet依从性每增加一个单位，HSI有统计学意义的下降（β = -0.075；95%置信区间：-0.128，-0.021）。
在心血管风险高的个体中，坚持MedDiet与HSI的改善显著相关。这些纵向研究结果突出了MedDiet在延迟或减缓MASLD自然进展中的重要作用，有助于其预防和临床管理。
