The Mediterranean diet and nonalcoholic fatty liver disease in individuals at high cardiovascular risk
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world, affecting about 30% of the world’s adult population (1,2). The disease ranges from simple steatosis (SS) to nonalcoholic steatohepatitis (NASH) (3). The prevalence of NAFLD is higher in patients with cardio metabolic risk and cardiac metabolic conditions are associated with increased risk of cardiovascular disease and type 2 diabetes. It is found in 50% of people with hypertension, 70% of diabetics and 90% of obese people (4). According to the “multiple-hit” theory of insulin resistance, lipotoxicity, nutritional factors, gastrointestinal microbiome, epigenetic and genetic factors are widely involved in the pathogenesis of this disease (5). As a result of obesity, visceral adipose tissue secretes adipokines, such as TNF-α and interleukins, which lead to vascular inflammation and insulin resistance (6). The first physiological event in NAFLD is insulin resistance. The severity of insulin resistance is associated with the severity of liver injury, from benign steatosis to advanced NASH and fibrosis (7).