The impact of the Mediterranean diet on liver steatosis and fibrosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease

Objective The study investigated the association between markers of liver steatosis and fibrosis and the adherence to the Mediterranean dietary pattern, evaluated by a diet-quality score, in patients with type 2 diabetes (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD). Methods Patients with T2DM and MASLD underwent a comprehensive medical evaluation, which included lifestyle, clinical, laboratory, and liver ultrasound assessment. The natural consumption of foods specific to the Mediterranean Diet (MedDiet) was investigated by a previously validated 14-item questionnaire (MedDiet Score). For the estimation of liver steatosis, the Index of NASH (Non-alcoholic steatohepatitis) (ION) was calculated by sex-specific formulas, while liver fibrosis was estimated by the Fibrosis-4 (FIB-4) score. Results Data from 271 patients were analyzed. The mean MedDiet Score was 4.55±1.59 points, and most patients scored 3 points (19.93%), 4 points (28.78%), and 5 points (21.40%). Patients with a MedDiet Score ≥5 points had lower fasting blood glucose, ferritin, C-peptide and HOMA-IR, and lower ION values (19.96 ±14.63 vs. 23.50±14.77; p=0.025). No significant differences were noted for FIB-4 values. MedDiet Score was negatively correlated with fasting blood glucose, ferritin, C-peptide, HOMA-IR, and ION values (r=-0.14 [-0.25; -0.01]; p=0.026), and positively with LDL cholesterol levels. Drinking less than one portion of sweet or carbonated beverages daily and eating at least 3 portions of nuts weekly was associated with lower ION values. Conclusions Low MedDiet Score was associated with markers of hepatic steatosis (but not fibrosis), worse insulin resistance, higher fasting hyperglycemia, and serum ferritin levels in patients with T2DM and MASLD.