Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Oct 3;24(1):2701.
doi: 10.1186/s12889-024-19378-w.

Efficacy of the Mediterranean diet in treating metabolic dysfunction-associated steatotic liver disease (MASLD) in children and adolescents: a systematic review and meta-analysis

Asma Jamil  1 , Tawanda Chivese  2 , Usra Elshaikh  3 , Marguerite Sendall  3   4
Affiliations
Meta-Analysis

Efficacy of the Mediterranean diet in treating metabolic dysfunction-associated steatotic liver disease (MASLD) in children and adolescents: a systematic review and meta-analysis

Asma Jamil et al. BMC Public Health. .

Abstract

Background: There are limited treatment options for metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic Fatty Liver Disease (MASLD) in children and adolescents.

Aim: To evaluate the effectiveness of the Mediterranean diet in improving liver function in children and adolescents with MASLD.

Methods: In this systematic review and meta-analysis, we searched PubMed, Scopus, Embase, CINAHL, and Cochrane CENTRAL for interventional studies investigating the effect of Mediterranean diet on MASLD in children and adolescents. The primary outcome was a change in liver function measured using these liver enzymes; Alanine Transaminase (ALT), Aspartate Transaminase (AST) and Gamma-glutamyl transferase (GGT). The secondary outcomes were lipid profile, body weight, and insulin resistance. The risk of bias was assessed using the MASTER scale. Bias-adjusted inverse variance heterogeneity models were used to synthesize overall weighted mean differences for the treatment effect (WMD) and their 95% confidence intervals. Heterogeneity and publication bias were evaluated using the I2 statistics, Tau-squared and Doi plots, respectively.

Result: Out of 5915 study records identified from database searches, five studies with 308 participants, two randomized controlled trials, and three quasi-experimental studies, met the inclusion criteria. In overall synthesis, the Mediterranean diet was associated with moderate improvements in liver function as shown by reductions in the liver enzymes [ALT - WMD - 10.85 U/L, 95% CI -20.03 to -1.68, I2 = 42, T2 = 38.8, AST - WMD - 9.26 U/L, 95% CI -17.14 to -1.38, I2 = 70.7, T2 = 42.7, and GGT - WMD - 1.99 95% CI -5.09 to 1.11)], but changes in body weight, lipid profile and insulin resistance were small and insignificant.

Conclusion: The Mediterranean diet may improve liver function in children with MASLD. More randomized controlled trials are needed to develop high-certainty evidence on these findings.

Registration: This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42023426939. 31/05/2023.

Keywords: Children; MASLD; Mediterranean diet; Non-alcoholic fatty liver disease; Pediatric.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Forest plot showing the effect of the Mediterranean diet compared to other diets on ALT
Fig. 3
Fig. 3
Forest plot showing the effect of the Mediterranean diet compared to other diets on AST
Fig. 4
Fig. 4
Forest plot showing effect of the Mediterranean diet compared to other diets GGT
Fig. 5
Fig. 5
Forest plot showing effect of the Mediterranean diet compared to other diets on HOMA-IR
Fig. 6
Fig. 6
Forest plot showing effect of the Mediterranean diet compared to other diets on HDL
Fig. 7
Fig. 7
Forest plot showing effect of the Mediterranean diet compared to other diets on HDL
Fig. 8
Fig. 8
Forest plot showing effect of the Mediterranean diet compared to other diets on Total Cholesterol
Fig. 9
Fig. 9
Forest plot showing the effect of the Mediterranean diet compared to other diets on body weight
See this image and copyright information in PMC

References

    1. Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN Clinical Practice Guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017;64(2):319–34. 10.1097/MPG.0000000000001482. - PMC - PubMed
    1. Le MH, Le DM, Baez TC, Wu Y, Ito T, Lee EY, et al. Global incidence of non-alcoholic fatty liver disease: a systematic review and meta-analysis of 63 studies and 1,201,807 persons. J Hepatol. 2023. 10.1016/j.jhep.2023.03.040. - PubMed
    1. Haigh L, Kirk C, El Gendy K, Gallacher J, Errington L, Mathers JC, et al. The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis. Clin Nutr. 2022;41(9):1913–31. 10.1016/j.clnu.2022.06.037. - PubMed
    1. Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012;54(5):700–13. 10.1097/MPG.0b013e318252a13f. - PubMed
    1. Yurtdas G, Akbulut G, Baran M, Yilmaz C. The effects of Mediterranean diet on hepatic steatosis, oxidative stress, and inflammation in adolescents with non-alcoholic fatty liver disease: a randomized controlled trial. Pediatr Obes. 2022;17(4):e12872. 10.1111/ijpo.12872. - PubMed