Aims:
The prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2D) is high and linked with poor prognosis. We aimed to explore the association between the adherence to the Mediterranean style diet and the severity of NAFLD among obese Chinese adults with T2D.
Methods:
A total of 103 obese T2D Chinese adults with body mass index (BMI) ≥30 kg/m2 and no history of excessive alcohol drinking received comprehensive diabetes-related complication assessments and underwent an ultrasound examination of fatty liver in a university-affiliated hospital. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. Adherence to the Mediterranean style diet was estimated with the Mediterranean Diet Score (MDS) (score range from 0-9 points).
Results:
NAFLD was present in 97 (94.2%) subjects of the study cohort (53% male, mean age = 52.3 ± 9.1 years, mean BMI = 34.6 ± 4.3 kg/m2). A total of 27 (26.2%), 56 (54.4%) and 20 (19.4%) subjects were graded as 'no or mild', 'moderate' and 'severe fatty liver', respectively. Compared with the 'no or mild' and 'moderate' groups, the 'severe fatty liver' group was higher in systolic BP, diastolic BP, glycated hemoglobin, triglyceride and alanine transaminase after adjusting for age and gender (all p-value <0.05). Using logistic regression models, MDS was independently and inversely associated with the presence of severe NAFLD after adjustment for potential confounders (p-value = 0.008). The odd ratio was 0.47 (95% confidence interval: 0.27-0.82) for every 1 point increase in MDS.
Conclusion:
Adherence to the Mediterranean style diet had an inverse association with the presence of severe NAFLD among obese Chinese adults with T2D. Lifestyle strategies addressing Mediterranean style diet may be warrranted in managing NAFLD in this patient population.