Mediterranean diet adherence and non-alcoholic fatty liver disease risk in Turkish adults: a case-control study

The Mediterranean diet has emerged as a promising dietary pattern for preventing non-alcoholic fatty liver disease (NAFLD). This study aimed to examine the role of the Mediterranean diet on the risk of NAFLD in Turkish adults. A total of 252 individuals (126 NAFLD and 126 age- and sex-matched controls) participated in this case-control study. Dietary intake was assessed with a 24-h recall, and adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Adherence Screener (MEDAS). Logistic regression models were applied to estimate OR. The prevalence of NAFLD was higher in the lowest tertile (64·6 %) and lower in the highest tertile (30·5 %; P < 0·001). Moderate adherence to the Mediterranean diet was associated with a 57·0 % lower risk of NAFLD after adjusting for age, sex, BMI and energy intake. High adherence conferred an 86·0 % reduction after adjusting for age, sex, BMI, energy intake and co-morbidities. Frequent consumption of butter, margarine, cream (OR = 2·75; 95 % CI 1·72, 6·43) and sugar-sweetened beverages (OR = 2·87; 95 % CI 1·20, 6·87) significantly increased the risk. However, consuming nuts three or more servings per week was protective (OR = 0·46; 95 % CI 0·21, 0·99). In individuals who did not consume ≥ 3 servings of fruit daily, the risk of NAFLD was significantly reduced (OR = 0·28; 95 % CI 0·16, 0·69). Adherence to the Mediterranean diet was strongly associated with a reduced risk of NAFLD, highlighting the importance of limiting saturated fats and sugar-sweetened beverages while promoting nuts as practical strategies for prevention.