Effect of a Low Glycemic Index Mediterranean Diet on Non-Alcoholic Fatty Liver Disease. A Randomized Controlled Clinici Trial

J Nutr Health Aging. 2017;21(4):404-412. doi: 10.1007/s12603-016-0809-8.


Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common form of liver disease worldwide affecting all ages and ethnic groups and it has become a consistent threat even in young people. Our aim was to estimate the effect of a Low Glycemic Index Mediterranean Diet (LGIMD) on the NAFLD score as measured by a Liver Ultrasonography (LUS).

Design: NUTRIzione in EPAtologia (NUTRIEPA) is a population-based Double-Blind RCT. Data were collected in 2011 and analyzed in 2013-14.

Setting/participants: 98 men and women coming from Putignano (Puglia, Southern Italy) were drawn from a previous randomly sampled population-based study and identified as having moderate or severe NAFLD.

Intervention: The intervention strategy was the assignment of a LGIMD or a control diet.

Outcome measures: The main outcome measure was NAFLD score, defined by LUS.

Results: After randomization, 50 subjects were assigned to a LGIMD and 48 to a control diet. The study lasted six months and all participants were subject to monthly controls/checks. Adherence to the LGIMD as measured by Mediterranean Adequacy Index (MAI) showed a median of 10.1. A negative interaction between time and LGIMD on the NAFLD score (-4.14, 95% CI -6.78,-1.49) was observed, and became more evident at the sixth month (-4.43, 95%CI -7.15, -1.71). A positive effect of the interaction among LGIMD, time and age (Third month: 0.07, 95% CI 0.02, 0.12; Sixth month: 0.08, 95% CI 0.03,0.13) was also observed.

Conclusions: LGIMD was found to decrease the NAFLD score in a relatively short time. Encouraging those subjects who do not seek medical attention but still have NAFLD to follow a LGIMD and other life-style interventions, may reduce the degree of severity of the disease. Dietary intervention of this kind, could also form the cornerstone of primary prevention of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease.

Trial registration: ClinicalTrials.gov NCT01798719.

Keywords: Hepatic steatosis; Mediterranean diet; low glycemic index Mediterranean diet.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / physiology
  • Blood Pressure / physiology
  • Body Height / physiology
  • Body Weight / physiology
  • Diabetes Mellitus, Type 2 / prevention & control
  • Diet, Mediterranean*
  • Double-Blind Method
  • Female
  • Glycemic Index / physiology*
  • Humans
  • Insulin / blood
  • Italy
  • Life Style
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / blood
  • Non-alcoholic Fatty Liver Disease / diet therapy*
  • Surveys and Questionnaires


  • Blood Glucose
  • Insulin

Associated data

  • ClinicalTrials.gov/NCT01798719