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Adherence to a Mediterranean diet may improve serum adiponectin in adults with nonalcoholic fatty liver disease: The MEDINA randomized controlled trial

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posted on 2023-11-17, 00:32 authored by Anj ReddyAnj Reddy, PD Gatta, S Mason, AJ Nicoll, M Ryan, Catherine Itsiopoulos, G Abbott, NA Johnson, S Sood, SK Roberts, Elena GeorgeElena George, Audrey TierneyAudrey Tierney
Nonalcoholic fatty liver disease (NAFLD) affects approximately 30% of adults worldwide, with chronic low-grade inflammation being a key pathophysiological feature of progression. The Mediterranean diet (MedDiet) is recognized for improving metabolic and hepatic outcomes in people with diabetes and NAFLD, in part, via anti-inflammatory properties. The aim of this study was to determine the effect of an ad libitum MedDiet versus low-fat diet (LFD) on inflammatory markers in adults with NAFLD. It was hypothesized that the MedDiet, and its individual components, would improve inflammation. This multicenter, randomized controlled trial, randomized participants to a MedDiet or LFD intervention for 12 weeks. Primary outcomes included change from baseline to 12 weeks for serum high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-α, adiponectin, leptin, and resistin. Forty-two participants (60% female; age 52.3 ± 12.6 years; body mass index, 32.2 ± 6.2 kg/m²) were randomized to the MedDiet (n = 19) or low-fat diet (n = 23). At 12 weeks, the LFD showed a greater decrease in leptin compared with the MedDiet (–1.20 ± 3.9 ng/mL vs 0.64 ± 3.5 ng/mL, P = .010). Adiponectin significantly improved within the MedDiet (13.7 ± 9.2 µg/mL to 17.0 ± 12.5 µg/mL, P = .016), but not within the LFD group. No statistically significant changes were observed for other inflammatory markers following the MedDiet or LFD. Adherence to the MedDiet significantly improved in both study arms, although greater improvements were seen in the MedDiet group. Adiponectin significantly improved following a Mediterranean diet intervention, in the absence of weight loss. The low-fat diet did not elicit improvements in inflammatory markers. High-quality clinical trials appropriately powered to inflammatory markers are required in this population.


This project was funded by a La Trobe University Research Focus Area 'Understanding Disease' grant. The analysis of inflammatory cytokine and adipokine markers was funded by an Australasian Society of Parenteral and Enteral Nutrition small project grant. This work was supported by an Australian Government Research Training Program Scholarship (A.R., E.S.G.). Food was donated for study participant hampers from Boundary Bend, Almond Board of Australia, Jalna, HJ Heinz, Simplot, and Carmen's; these companies had no input into the trial design or delivery.


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Nutrition Research




11p. (p. 98-108)





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© 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (

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