{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:04:59Z","timestamp":1793156699285,"version":"4.5.0"},"reference-count":84,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> With no approved pharmacotherapy to date, the present therapeutic cornerstone for non-alcoholic fatty liver diseases (NAFLD) is a lifestyle intervention. Guidelines endorse weight loss through dietary modifications, physical exercise, or both. However, no consensus exists on the optimal dietary treatment.<\/jats:p><jats:p><jats:bold>Objectives:<\/jats:bold> The aim of our systematic review and meta-analysis was to summarize and assess the evidence for applied types of dietary interventions on the liver and metabolic outcomes in patients with NAFLD, aside from any effects of exercise intervention.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This systematic review was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement guidelines. The search was conducted in PubMed, Scopus, and Cochrane databases in February 2020. Included were only dietary interventions without exercise. This study was registered at PROSPERO: CRD42020203573.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Eight randomized controlled trials, seven with endpoint reduction of hepatic steatosis, one with an assessment of endpoint fibrosis, were included in this systematic review, five of which were included in the meta-analysis. Mediterranean dietary interventions without energy restriction (<jats:italic>n<\/jats:italic> = 3) showed significant reduction of intrahepatic lipid content (IHL) (SDM: \u22120.57, 95% CI: \u22121.04, \u22120.10), but there was no significant change in alanine transaminase (ALT) (SDM: 0.59, 95% CI: \u22120.5, \u22121.68). Hypocaloric dietary interventions with foods high in unsaturated fatty acids (<jats:italic>n<\/jats:italic> = 2) led to a significant decrease in ALT (SDM: \u22121.09, 95% CI: \u22121.49, \u22120.69) and aspartate aminotransferase (AST) (SDM: \u22120.75, 95% CI: \u22121.27, 0.23); yet effects on steatosis could not be aggregated due to different assessment techniques. Mediterranean diet did not lead to significant changes in concentrations of gamma-glutamyl transpeptidase (\u03b3GT), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), fasting glucose or insulin, or homeostatic assessment for insulin resistance.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> In patients with NAFLD, Mediterranean and hypocaloric dietary interventions favoring unsaturated fatty acids result in improvements in IHL and transaminases. Since many dietary intervention studies are combined with exercise interventions and there is a paucity of ample-sized studies examining dietary interventions on the more advanced and clinically relevant stages of NAFLD, that is active and fibrotic NASH, with multiparametric imaging and liver histology as outcome measures, the optimal dietary invention in NAFLD remains to be defined.<\/jats:p>","DOI":"10.3389\/fnut.2021.716783","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T09:14:27Z","timestamp":1626945267000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":91,"title":["Dietary Interventions in Patients With Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis"],"prefix":"10.3389","volume":"8","author":[{"given":"Veera","family":"Houttu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Csader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Nieuwdorp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriaan G.","family":"Holleboom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Schwab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2672","DOI":"10.1002\/hep.30251","article-title":"Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis","volume":"69","author":"Younossi","year":"2019","journal-title":"Hepatology."},{"key":"B3","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.cgh.2016.08.028","article-title":"Nonobese fatty liver disease","volume":"15","author":"Kim","year":"2017","journal-title":"Clin Gastroenterol Hepatol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1002\/cld.81","article-title":"Nonalcoholic fatty liver disease: definitions, risk factors, and workup","volume":"1","author":"Puri","year":"2012","journal-title":"Clin liver Dis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"9674","DOI":"10.3748\/wjg.v22.i44.9674","article-title":"Fatty liver is associated with an increased risk of diabetes and cardiovascular disease - Evidence from three different disease models: NAFLD, HCV and HIV","volume":"22","author":"Lonardo","year":"2016","journal-title":"World J Gastroenterol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/03602532.2017.1293683","article-title":"Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters","volume":"49","author":"Cobbina","year":"2017","journal-title":"Drug Metab Rev."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1053\/j.gastro.2020.01.052","article-title":"Nonalcoholic fatty liver disease 2020: the state of the disease","volume":"158","author":"Cotter","year":"2020","journal-title":"Gastroenterology."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1002\/hep.29085","article-title":"Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis","volume":"65","author":"Dulai","year":"2017","journal-title":"Hepatology."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1053\/j.gastro.2020.01.043","article-title":"Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis","volume":"158","author":"Taylor","year":"2020","journal-title":"Gastroenterology."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1023\/a:1005661516165","article-title":"Fatty infiltration of liver in hyperlipidemic patients","volume":"45","author":"Assy","year":"2000","journal-title":"Dig Dis Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1111\/j.1478-3231.2008.01718.x","article-title":"Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus","volume":"29","author":"Leite","year":"2009","journal-title":"Liver Int."},{"key":"B12","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.jhep.2019.06.021","article-title":"The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis","volume":"71","author":"Younossi","year":"2019","journal-title":"J Hepatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1038\/ajg.2014.132","article-title":"Mortality from chronic liver diseases in diabetes","volume":"109","author":"Zoppini","year":"2014","journal-title":"Am J Gastroenterol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"76","DOI":"10.14218\/JCTH.2019.00051","article-title":"Non-alcoholic fatty liver disease: growing burden, adverse outcomes and associations","volume":"8","author":"Kumar","year":"2020","journal-title":"J Clin Transl Hepatol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"467","DOI":"10.3389\/fmed.2020.00467","article-title":"Disturbances in cholesterol homeostasis and non-alcoholic fatty liver diseases","volume":"7","author":"Malhotra","year":"2020","journal-title":"Front Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/j.jhep.2007.06.020","article-title":"Long term nutritional intake and the risk for non-alcoholic fatty liver disease (NAFLD): a population based study","volume":"47","author":"Zelber-Sagi","year":"2007","journal-title":"J Hepatol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"9127","DOI":"10.3390\/nu7115454","article-title":"Nutritional modulation of non-alcoholic fatty liver disease and insulin resistance","volume":"7","author":"Yki-J\u00e4rvinen","year":"2015","journal-title":"Nutrients."},{"key":"B18","doi-asserted-by":"publisher","first-page":"2669","DOI":"10.3748\/wjg.v26.i20.2669","article-title":"Association between non-alcoholic fatty liver disease and obstructive sleep apnea","volume":"26","author":"Umbro","year":"2020","journal-title":"World J Gastroenterol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1038\/s41575-020-0269-9","article-title":"Gut microbiota and human NAFLD: disentangling microbial signatures from metabolic disorders","volume":"17","author":"Aron-Wisnewsky","year":"2020","journal-title":"Nat Rev Gastroenterol Hepatol."},{"key":"B20","first-page":"43","article-title":"Nonalcoholic Fatty liver disease and psoriasis: what a dermatologist needs to know","volume":"8","author":"Prussick","year":"2015","journal-title":"J Clin Aesthet Dermatol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2005","DOI":"10.1002\/hep.25762","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association","volume":"55","author":"Chalasani","year":"2012","journal-title":"Hepatology."},{"key":"B22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1159\/000443344","article-title":"EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease","volume":"9","year":"2016","journal-title":"Obes Facts."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3533","DOI":"10.1016\/j.clnu.2020.09.001","article-title":"ESPEN practical guideline: clinical nutrition in liver disease","volume":"39","author":"Bischoff","year":"2020","journal-title":"Clin Nutr."},{"key":"B24","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1053\/j.gastro.2020.11.051","article-title":"AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease: expert review","volume":"160","author":"Younossi","year":"2021","journal-title":"Gastroenterology."},{"key":"B25","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1053\/j.gastro.2015.04.005","article-title":"Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis","volume":"149","author":"Vilar-Gomez","year":"2015","journal-title":"Gastroenterology."},{"key":"B26","doi-asserted-by":"publisher","first-page":"G329","DOI":"10.1152\/ajpgi.00044.2018","article-title":"Lifestyle intervention for morbid obesity: effects on liver steatosis, inflammation, and fibrosis","volume":"315","author":"Hohenester","year":"2018","journal-title":"Am J Physiol Gastrointest Liver Physiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3390\/nu9030230","article-title":"Fructose and NAFLD: the multifaceted aspects of fructose metabolism","volume":"9","author":"Jegatheesan","year":"2017","journal-title":"Nutrients."},{"key":"B28","doi-asserted-by":"publisher","first-page":"3377","DOI":"10.3748\/wjg.v17.i29.3377","article-title":"Nutrition and physical activity in NAFLD: an overview of the epidemiological evidence","volume":"17","author":"Zelber-Sagi","year":"2011","journal-title":"World J Gastroenterol."},{"key":"B29","unstructured":"Non-Alcoholic Fatty Liver Disease (NAFLD). Current Care Guidelines. Helsinki Finnish Med Soc Duodecim.2020"},{"key":"B30","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1111\/j.1478-3231.2011.02730.x","article-title":"The potential role of prebiotic fibre for treatment and management of non-alcoholic fatty liver disease and associated obesity and insulin resistance","volume":"32","author":"Parnell","year":"2012","journal-title":"Liver Int."},{"key":"B31","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.clnesp.2019.10.008","article-title":"The effect of a Mediterranean diet on metabolic parameters in patients with non-alcoholic fatty liver disease: A systematic review of randomized controlled trials","volume":"35","author":"Moosavian","year":"2020","journal-title":"Clin Nutr ESPEN."},{"key":"B32","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1038\/s41430-020-00778-1","article-title":"Effects of dietary macronutrients on liver fat content in adults: a systematic review and meta-analysis of randomized controlled trials","volume":"75","author":"Winters-van Eekelen","year":"2021","journal-title":"Eur J Clin Nutr."},{"key":"B33","doi-asserted-by":"publisher","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ."},{"key":"B34","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B35","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev."},{"key":"B36","first-page":"1","article-title":"Vitamin D and calcium: a systematic review of health outcomes","volume":"183","author":"Chung","year":"2009","journal-title":"Evid Rep Technol Assess."},{"key":"B37","article-title":"No Title","author":"Higgins","year":"2021","journal-title":"Cochrane Handb Syst Rev Interv version"},{"key":"B38","doi-asserted-by":"publisher","first-page":"147","DOI":"10.5681\/hpp.2011.016","article-title":"Lifestyle modification through dietary intervention: health promotion of patients with non-alcoholic fatty liver disease","volume":"1","author":"Arefhosseini","year":"2011","journal-title":"Heal Promot Perspect."},{"key":"B39","doi-asserted-by":"publisher","first-page":"E22","DOI":"10.1111\/hepr.12918","article-title":"Comparison of efficacy of low-carbohydrate and low-fat diet education programs in non-alcoholic fatty liver disease: A randomized controlled study","volume":"48","author":"Jang","year":"2018","journal-title":"Hepatol Res."},{"key":"B40","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1111\/liv.12990","article-title":"The effects of DASH diet on weight loss and metabolic status in adults with non-alcoholic fatty liver disease: a randomized clinical trial","volume":"36","author":"Razavi Zade","year":"2016","journal-title":"Liver Int."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1053710","DOI":"10.1155\/2018\/1053710","article-title":"The effects of extra virgin olive oil on alanine aminotransferase, aspartate aminotransferase, and ultrasonographic indices of hepatic steatosis in nonalcoholic fatty liver disease patients undergoing low calorie diet","volume":"2018","author":"Shidfar","year":"2018","journal-title":"Can J Gastroenterol Hepatol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1017\/S0007114519002769","article-title":"Whole-grain consumption and its effects on hepatic steatosis and liver enzymes in patients with non-alcoholic fatty liver disease: a randomised controlled clinical trial","volume":"123","author":"Dorosti","year":"2020","journal-title":"Br J Nutr."},{"key":"B43","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1007\/s12603-016-0809-8","article-title":"Effect of a low glycemic index mediterranean diet on non-alcoholic fatty liver disease. A randomized controlled clinici trial","volume":"21","author":"Misciagna","year":"2017","journal-title":"J Nutr Health Aging."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1002\/hep.30076","article-title":"Ad libitum mediterranean and low-fat diets both significantly reduce hepatic steatosis: a randomized controlled trial","volume":"68","author":"Properzi","year":"2018","journal-title":"Hepatology."},{"key":"B45","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.jhep.2013.02.012","article-title":"The mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease","volume":"59","author":"Ryan","year":"2013","journal-title":"J Hepatol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1056\/NEJM199704173361601","article-title":"A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group","volume":"336","author":"Appel","year":"1997","journal-title":"N Engl J Med."},{"key":"B47","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/s40200-019-00475-2","article-title":"Mediterranean diet for patients with non-alcoholic fatty liver disease, a systematic review and meta-analysis of observational and clinical investigations","volume":"19","author":"Akhlaghi","year":"2020","journal-title":"J Diabetes Metab Disord."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1111\/jgh.15363","article-title":"Relationship between dietary patterns and non-alcoholic fatty liver disease: A systematic review and meta-analysis","volume":"36","author":"Hassani Zadeh","year":"2020","journal-title":"J Gastroenterol Hepatol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-323106","article-title":"Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial","author":"Yaskolka Meir","year":"2021","journal-title":"Gut"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1002\/hep.30967","article-title":"Diet associations with nonalcoholic fatty liver disease in an ethnically diverse population: the multiethnic cohort","volume":"71","author":"Noureddin","year":"2020","journal-title":"Hepatology."},{"key":"B51","doi-asserted-by":"publisher","first-page":"641","DOI":"10.3390\/biom10040641","article-title":"Phenolic compounds exerting lipid-regulatory, anti-inflammatory and epigenetic effects as complementary treatments in cardiovascular diseases","volume":"10","author":"Toma","year":"2020","journal-title":"Biomolecules."},{"key":"B52","doi-asserted-by":"publisher","first-page":"366","DOI":"10.3390\/molecules24020366","article-title":"Roles of phenolic compounds in the reduction of risk factors of cardiovascular diseases","volume":"24","author":"Lutz","year":"2019","journal-title":"Molecules."},{"key":"B53","doi-asserted-by":"publisher","first-page":"870","DOI":"10.3390\/nu9080870","article-title":"Effect of mediterranean diet and antioxidant formulation in non-alcoholic fatty liver disease: a randomized study","volume":"9","author":"Abenavoli","year":"2017","journal-title":"Nutrients."},{"key":"B54","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1038\/s41591-020-01223-3","article-title":"The gut microbiome modulates the protective association between a Mediterranean diet and cardiometabolic disease risk","volume":"27","author":"Wang","year":"2021","journal-title":"Nat Med."},{"key":"B55","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1016\/j.cmet.2019.08.018","article-title":"Fatty liver disease caused by high-alcohol-producing klebsiella pneumoniae","volume":"30","author":"Yuan","year":"2019","journal-title":"Cell Metab."},{"key":"B56","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1002\/hep.26093","article-title":"Characterization of gut microbiomes in nonalcoholic steatohepatitis (NASH) patients: a connection between endogenous alcohol and NASH","volume":"57","author":"Zhu","year":"2013","journal-title":"Hepatology."},{"key":"B57","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1053\/j.gastro.2019.06.028","article-title":"Microbiome signatures associated with steatohepatitis and moderate to severe fibrosis in children with nonalcoholic fatty liver disease","volume":"157","author":"Schwimmer","year":"2019","journal-title":"Gastroenterology."},{"key":"B58","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/j.chom.2019.05.005","article-title":"Daily sampling reveals personalized diet-microbiome associations in humans","volume":"25","author":"Johnson","year":"2019","journal-title":"Cell Host Microbe."},{"key":"B59","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1002\/hep.23276","article-title":"Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis","volume":"51","author":"Promrat","year":"2010","journal-title":"Hepatology."},{"key":"B60","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1007\/s00125-011-2446-4","article-title":"Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials","volume":"55","author":"Musso","year":"2012","journal-title":"Diabetologia."},{"key":"B61","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1016\/j.jhep.2013.04.013","article-title":"Community-based lifestyle modification programme for non-alcoholic fatty liver disease: a randomized controlled trial","volume":"59","author":"Wong","year":"2013","journal-title":"J Hepatol."},{"key":"B62","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1093\/alcalc\/ags072","article-title":"Effect of age and gender on the relationship between alcohol consumption and serum GGT: time to recalibrate goals for normal ranges","volume":"47","author":"Tynj\u00e4l\u00e4","year":"2012","journal-title":"Alcohol Alcohol."},{"key":"B63","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/s1059-1311(97)80007-6","article-title":"Basic haematological parameters, serum gamma-glutamyl-transferase activity, and erythrocyte folate and serum vitamin B12 levels during carbamazepine and oxcarbazepine therapy","volume":"6","author":"Isoj\u00e4rvi","year":"1997","journal-title":"Seizure."},{"key":"B64","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1177\/000456329603300607","article-title":"The effects of cigarette smoking and alcohol consumption on serum liver enzyme activities: a dose-related study in men","volume":"33","author":"Whitehead","year":"1996","journal-title":"Ann Clin Biochem."},{"key":"B65","doi-asserted-by":"publisher","first-page":"818570","DOI":"10.1155\/2015\/818570","article-title":"Gamma-glutamyltransferase: a predictive biomarker of cellular antioxidant inadequacy and disease risk","volume":"2015","author":"Koenig","year":"2015","journal-title":"Dis Markers."},{"key":"B66","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1007\/s00125-017-4340-1","article-title":"Use of HOMA-IR to diagnose non-alcoholic fatty liver disease: a population-based and inter-laboratory study","volume":"60","author":"Isokuortti","year":"2017","journal-title":"Diabetologia."},{"key":"B67","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1016\/S2213-8587(14)70032-4","article-title":"Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome","volume":"2","author":"Yki-J\u00e4rvinen","year":"2014","journal-title":"Lancet Diabetes Endocrinol."},{"key":"B68","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.clnesp.2020.03.003","article-title":"Effects of the Mediterranean diet on cardiovascular risk factors in non-alcoholic fatty liver disease patients: A systematic review and meta-analysis","volume":"37","author":"Asbaghi","year":"2020","journal-title":"Clin Nutr ESPEN."},{"key":"B69","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1111\/joim.12036","article-title":"Identifying cardiovascular disease risk and outcome: use of the plasma triglyceride\/high-density lipoprotein cholesterol concentration ratio versus metabolic syndrome criteria","volume":"273","author":"Salazar","year":"2013","journal-title":"J Intern Med."},{"key":"B70","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/jdi.13118","article-title":"Higher triglyceride to high-density lipoprotein cholesterol ratio increases cardiovascular risk: 10-year prospective study in a cohort of Chinese adults","volume":"11","author":"Chen","year":"2020","journal-title":"J Diabetes Investig."},{"key":"B71","doi-asserted-by":"publisher","first-page":"e0200017","DOI":"10.1371\/journal.pone.0200017","article-title":"Long-term moderately elevated LDL-cholesterol and blood pressure and risk of coronary heart disease","volume":"13","author":"Ueda","year":"2018","journal-title":"PLoS ONE."},{"key":"B72","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1111\/j.1753-4887.2006.tb00219.x","article-title":"The role of dietary supplementation with plant sterols and stanols in the prevention of cardiovascular disease","volume":"64","author":"Devaraj","year":"2006","journal-title":"Nutr Rev."},{"key":"B73","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s11745-015-4020-1","article-title":"Acute intake of plant stanol esters induces changes in lipid and lipoprotein metabolism-related gene expression in the liver and intestines of mice","volume":"50","author":"De Smet","year":"2015","journal-title":"Lipids."},{"key":"B74","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/BF03165972","article-title":"Role of naturally-occurring plant sterols on intestinal cholesterol absorption and plasmatic levels","volume":"65","author":"Sanclemente","year":"2009","journal-title":"J Physiol Biochem."},{"key":"B75","doi-asserted-by":"publisher","first-page":"CD011737","DOI":"10.1002\/14651858.CD011737.pub3","article-title":"Reduction in saturated fat intake for cardiovascular disease","volume":"8","author":"Hooper","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"B76","doi-asserted-by":"publisher","first-page":"101215","DOI":"10.1016\/j.diabet.2020.101215","article-title":"NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment","volume":"47","author":"Targher","year":"2021","journal-title":"Diabetes Metab."},{"key":"B77","doi-asserted-by":"publisher","first-page":"562","DOI":"10.14309\/ajg.0000000000000484","article-title":"Disease severity is associated with higher healthcare utilization in nonalcoholic steatohepatitis medicare patients","volume":"115","author":"CGordon","year":"2020","journal-title":"Am J Gastroenterol."},{"key":"B78","doi-asserted-by":"publisher","first-page":"e23506","DOI":"10.1097\/MD.0000000000023506","article-title":"Disease severity predicts higher healthcare costs among hospitalized nonalcoholic fatty liver disease\/nonalcoholic steatohepatitis (NAFLD\/NASH) patients in Spain","volume":"99","author":"Romero-Gomez","year":"2020","journal-title":"Medicine."},{"key":"B79","doi-asserted-by":"publisher","first-page":"100142","DOI":"10.1016\/j.jhepr.2020.100142","article-title":"Cost of non-alcoholic steatohepatitis in Europe and the USA: The GAIN study","volume":"2","author":"O'Hara","year":"2020","journal-title":"JHEP Rep Innov Hepatol."},{"key":"B80","doi-asserted-by":"publisher","first-page":"100099","DOI":"10.1016\/j.jhepr.2020.100099","article-title":"Health-related quality of life and patient-reported outcome measures in NASH-related cirrhosis","volume":"2","author":"McSweeney","year":"2020","journal-title":"JHEP Rep Innov Hepatol."},{"key":"B81","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/eurpub\/ckl262","article-title":"Diet and exercise intervention in a general population\u2013mediators of participation and adherence: the Inter99 study","volume":"17","author":"Toft","year":"2007","journal-title":"Eur J Public Health."},{"key":"B82","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1186\/s12889-018-5114-5","article-title":"\u201cI've made this my lifestyle now\u201d: a prospective qualitative study of motivation for lifestyle change among people with newly diagnosed type two diabetes mellitus","volume":"18","author":"Sebire","year":"2018","journal-title":"BMC Public Health."},{"key":"B83","doi-asserted-by":"publisher","first-page":"100234","DOI":"10.1016\/j.jhepr.2021.100234","article-title":"European \u201cNAFLD Preparedness Index\u201d - Is Europe ready to meet the challenge of fatty liver disease?","volume":"3","author":"Lazarus","year":"2021","journal-title":"JHEP Rep Innov Hepatol."},{"key":"B84","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.jhep.2019.08.027","article-title":"A cross-sectional study of the public health response to non-alcoholic fatty liver disease in Europe","volume":"72","author":"Lazarus","year":"2020","journal-title":"J Hepatol."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2021.716783\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T09:14:39Z","timestamp":1626945279000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2021.716783\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,22]]},"references-count":84,"alternative-id":["10.3389\/fnut.2021.716783"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2021.716783","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,22]]},"article-number":"716783"}}