Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2017; 23(17): 3150-3162
Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3150
Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease
Chiara Gelli, Mirko Tarocchi, Ludovico Abenavoli, Laura Di Renzo, Andrea Galli, Antonino De Lorenzo
Chiara Gelli, Laura Di Renzo, Antonino De Lorenzo, Division of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 0133 Rome, Italy
Chiara Gelli, Mirko Tarocchi, Andrea Galli, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
Ludovico Abenavoli, Department of Health Sciences, University Magna Graecia, Campus Germaneto, 88100 Catanzaro, Italy
Author contributions: Gelli C and Tarocchi M contributed equally to this work; Gelli C and Tarocchi M designed and performed the research; Gelli C wrote the manuscript; Tarocchi M, Di Renzo L, De Lorenzo A, Galli A and Abenavoli L reviewed and edited the manuscript; all authors read and approved the manuscript.
Supported by Fondo per gli Investimenti della Ricerca di Base, No. RBAP10MY35_002; Ente Cassa di Risparmio di Firenze; and FiorGen ONLUS to Galli A.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee “Centro, RC” n.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors confirm that this article content has no conflict of interest.
Data sharing statement: Dataset available from the corresponding author at mirko.tarocchi@unifi.it.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Mirko Tarocchi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134 Florence, Italy. mirko.tarocchi@unifi.it
Telephone: +39-55-2758115 Fax: +39-55-2758119
Received: December 20, 2016
Peer-review started: December 22, 2016
First decision: January 10, 2017
Revised: February 13, 2017
Accepted: April 13, 2017
Article in press: April 13, 2017
Published online: May 7, 2017

To determine the clinical effectiveness of nutritional counseling on reduction of non-alcoholic fatty liver disease (NAFLD) severity, weight loss, metabolic and anthropometric indexes and liver enzymes.


Forty-six adults with NAFLD received a 6-mo clinical and a dietary intervention (based on Mediterranean diet) carried out respectively by a gastroenterologist and a nutritionist with counseling license. The counseling process consisted of monthly meeting (about 45 min each). The effect of the treatment was evaluated monitoring liver enzymes, metabolic parameters, cardiovascular risk indexes, NAFLD severity [assessed by ultrasound (US)] and related indexes. All parameters were assessed at baseline. Biochemistry was also assessed at mid- and end-interventions and US was repeated at end-intervention.


The percentage of patients with steatosis grade equal or higher than 2 was reduced from 93% to 48% and steatosis regressed in 9 patients (20%). At the end of the treatment the end-point concerning the weight (i.e., a 7% weight reduction or achievement/maintenance of normal weight) was accomplished by 25 out of 46 patients (i.e., 54.3%). As far as the liver enzymes is concerned, all three liver enzymes significantly decrease during the treatment the normalization was particularly evident for the ALT enzyme (altered values reduced from 67% down to 11%). Several parameters, i.e., BMI, waist circumference, waist-to-hip ratio, AST, ALT, GGT, HDL, serum glucose, Tot-Chol/HDL, LDL/HDL, TG/HDL, AIP, HOMA, FLI, Kotronen index, VAI, NAFLD liver fat score and LAP, showed a significant improvement (P < 0.01) between baseline and end-treatment.


Outcomes of this study further strengthen the hypothesis that MedDiet and more active lifestyle can be considered a safe therapeutic approach for reducing risk and severity of NAFLD and related disease states. The proposed approach may be proposed as a valid and recommended approach for improving the clinical profile of NAFLD patients.

Keywords: Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Mediterranean diet, Metabolic syndrome, Therapeutic approach, Counseling, Diet, Life-style

Core tip: Most recent advances in the management and treatment of Non-alcoholic fatty liver disease (NAFLD) show that a multifaceted approach is likely to achieve the best outcomes. Our study evaluates the effectiveness of 6-mo multidisciplinary approach jointly carried out by a gastroenterologist and a nutritionist with counseling license. The approach was effective on the reduction of NAFLD severity, weight, anthropometric indexes, cardiovascular disease risk factors and the normalization of metabolic index, as well as liver enzymes. This study strengthens the hypothesis that MedDiet and more active lifestyle can be considered a safe therapeutic approach for reducing severity of NAFLD.