Mediterranean Diet May Help Reduce Risk of Adverse Liver-Related Outcomes in MASLD

Tsubasa Tsutsumi, MD, PhD

Credit: Tsubasa Tsutsumi on LinkedIn

New research is calling attention to additional hepatic benefits of the Mediterranean diet, demonstrating patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and higher Mediterranean diet scores have a lower risk of liver-related outcomes as measured by the Liver Risk score.

Study results were presented at The Liver Meeting 2024 from the American Association for the Study of Liver Diseases (AASLD) in San Diego, California, by Tsubasa Tsutsumi, MD, PhD, a staff scientist at the University of Chicago, and build upon the known benefits of the Mediterranean diet for hepatic fat and fibrosis, suggesting it is also associated with a reduced risk of long-term liver-related outcomes.

“Diet and nutrition are perceived to be cornerstones of metabolic and liver health,” Tsutsumi and colleagues wrote. “Based on overwhelming scientific evidence, the Mediterranean diet is a common component of dietary recommendations. Although patients with higher Mediterranean Diet Scores have been shown to exhibit lower hepatic fat and fibrosis, the impact of the Mediterranean diet on major adverse liver-related outcomes is not well established.”

To address this gap in research, investigators analyzed National Health and Nutrition Examination Survey (NHANES) 2017 to 2018 data for 3004 patients 40-80 years of age with complete dietary, physical, and laboratory data. Steatotic liver disease was diagnosed using a FibroScan with a Controlled Attenuation Parameter > 288 dB/m and IQR/Med ≤ 0.3.

Investigators calculated the Mediterranean Diet score based on the sum of 2-day interview results for 9 food groups, assigning scores of -1, 0, or 1 based on relative intake within the cohort, and summing these for a total score ranging from -1 to 8. This score was further classified into tertiles based on its distribution.

Citing the superior predictive accuracy of the Liver Risk score compared with FIB-4 and APRI scores, investigators used this score to reflect the early diagnosis of liver fibrosis and risk for major adverse liver-related outcomes in this population. Derived from age, glucose, cholesterol, AST, ALT, GGT and platelets, a Liver Risk score ≥ 6 was classified as high-risk.

Among the NHANES cohort (n = 3004), 1156 individuals with a mean age of 60 years and who were predominantly male (50.3%) had steatotic liver disease. Investigators divided patients into 3 groups based on their adherence to the Mediterranean diet: MED1 (n = 675), MED2 (n = 1219), and MED3 (n = 1109), with MED3 being the most adherent. There were no significant differences in age, sex, fatty liver, hypo HDL-C, hypertension, hyper TG, prevalence of obesity, and FIB-4 index among the 3 groups.

Logistic regression analysis revealed diabetes (Odds ratio [OR], 4.03; 95% CI, 3.32 to 4.90), SLD (OR, 1.72; 95% CI, 1.42 to 2.09), hypertension (OR, 1.52; 95% CI, 1.18 to 1.96), and hypertriglyceridemia (OR, 1.41; 95% CI, 1.16 to 1.71) were factors associated with a high-risk Liver Risk score. Of note, MED3, compared with MED1 (OR, 0.72, 95%CI, 0.57 to 0.92), and female gender were associated with a significantly lower risk group for Liver Risk score (OR, 0.27; 95%CI, 0.22 to 0.33).

“Strong adherence to a Mediterranean diet is associated with a lower risk of liver-related outcomes as measured by the Liver Risk score,” investigators concluded.1 “Males and patients with diabetes and hypertension are particularly at risk for higher Liver Risk score and may be more appropriate targets. Diet may impact long-term risk for major adverse liver-related outcomes.”

Reference

^{Tsutsumi T, Rinella M, Vilt S, et al. High adherence to the Mediterranean diet is associated with lower Liver Risk Scores – Analysis of the NHANES 2017-2018 Cohort. Paper presented at: AASLD’s The Liver Meeting 2024. San Diego, California. November 15-19, 2024.}