For patients with non-alcoholic fatty liver disease (NAFLD), a Mediterranean diet as well as antioxidant supplementation can improve anthropometric parameters and lipid profile and reduce hepatic fat accumulation and liver stiffness, according to a study published in Nutrients.

Ludovico Abenavoli, MD, PhD, MSc, from the Università Catanzaro in Italy, and colleagues conducted a randomized, prospective study of 50 Caucasian patients with a body mass index (BMI) greater than 25 kg/m2, who were enrolled in an outpatient gastroenterology clinic from June 2015 to June 2016. The patients were randomized by a systematic sampling procedure into 3 groups: A, B, or C. A personalized moderately low-calorie Mediterranean diet (1400–1600 kcal per day) was prescribed to group A and B patients for a 6-month period. In association with the diet, group B patients were administered two pills of Bilirel (BIL) complex daily for the same amount of time.

Liver ultrasound was performed to diagnose NAFLD. The hepatic fat accumulation grade was calculated as follows: absent (score 0), mild (1), moderate (2), and severe (3), according to the Hamaguchi score. Each patient also underwent liver stiffness measurement by transient elastography.

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Group A included 20 patients (12 male; median age, 52 years); group B included 20 patients (16 male; median age, 46 years); group C included 10 patients (6 male; median age, 33 years). After 6 months, group A patients had a statistically significant decrease in weight, BMI, and waist and hip circumference and an improvement of lipid profile with a significant decrease in triglycerides (TGs), total cholesterol, and low-density cholesterol (LDL-C).

In group B patients, a statistically significant decrease was observed in body weight, BMI, waist and hip circumference, and systolic blood pressure, as well as in alanine aminotransferase (ALT), fasting glucose, insulin, TG, total cholesterol, and LDL-C blood levels. Additionally, the researchers found in group B patients, who underwent both diet and BIL complex treatment, a statistically significant reduction in fasting glucose, insulin levels, and, consequently, HOMA-IR index, compared with group A patients. Inter-group analysis of all tested parameters showed that fasting glucose and insulin level, HOMA-IR, FL index, and TE values were significantly lower in group B than in group A, after the treatment period.

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“Our study confirms that the Mediterranean diet can improve anthropometric parameters and lipid profile and can contribute to reducing hepatic fat accumulation and liver stiffness,” the authors said. “Moreover, the association of this dietetic regimen with antioxidant supplementation can contribute to improving the insulin sensitivity parameters.”


  1. Abenavoli L, Greco M, Milic N, et al. Effect of Mediterranean diet and antioxidant formulation in non-alcoholic fatty liver disease: A randomized study. Nutrients. 2017 Aug 12. doi: 10.3390/nu9080870