The impact of the Mediterranean diet on liver steatosis and fibrosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease

Abstract

Objective. The aim of the study was to investigate the association between the adherence to the Mediterranean diet (MedDiet) and markers of liver steatosis and fibrosis in patients with type 2 diabetes (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods. Patients with T2DM and MASLD underwent a comprehensive medical evaluation, which included lifestyle, clinical, laboratory, and liver ultrasound assessment. The adherence to the Mediterranean Diet was investigated by a previously validated 14-item questionnaire. For the estimation of liver steatosis, the Index of NASH (Non-alcoholic steatohepatitis) (ION) was calculated by sex-specific formulas, while liver fibrosis was estimated with the Fibrosis-4 (FIB4) score.

Results. Data from 271 patients were analyzed. The mean MedDiet score was 4.55±1.59 points, and most patients scored 3 points (19.93%), 4 points (28.78%), and 5 points (21.40%). Patients with a MedDiet score ≥5 points had lower fasting blood glucose, ferritin, C peptide and HOMA-IR and ION values (19.96 ±14.63 vs. 23.50±14.77; p=0.025). No significant differences were noted for FIB4 values. MedDiet score was negatively correlated with fasting blood glucose, ferritin, C peptide, HOMA-IR and ION values (r=-0.14 [-0.25; -0.01]; p=0.026), and positively with LDL cholesterol levels. Drinking less than one portion of sweet or carbonated beverages daily and eating at least 3 portions of nuts weekly was associated with lower ION values.

Conclusions. Low adherence to MedDiet was associated with markers of hepatic steatosis (but not fibrosis), worse insulin resistance, higher fasting hyperglycemia, and serum ferritin levels in patients with T2DM and MASLD.