{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:49:36Z","timestamp":1790635776713,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"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:sec><jats:title>Background<\/jats:title><jats:p>Evidence suggests the role of changing traditional lifestyle patterns, such as Paleolithic, to the modern lifestyle in the incidence and epidemic of chronic diseases. The purpose of this study was to investigate the associations between the Paleolithic diet (PD) and the Paleolithic-like lifestyle and the risk of non-alcoholic fatty liver disease (NAFLD) among an adult population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This case-control study was carried out among 206 patients with NAFLD and 306 healthy subjects aged &amp;gt;18 years. PD score was evaluated using a validated 168-item quantitative food frequency questionnaire. In addition, to calculate the Paleolithic-like lifestyle score, the components of physical activity, body mass index (BMI), and smoking status of the participants were combined with the score of the PD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean PD and Paleolithic-like lifestyle scores were 38.11 \u00b1 5.63 and 48.92 \u00b1 6.45, respectively. After adjustment for potential confounders, higher scores of adherence to the PD diet conferred a protection for the presence of NAFLD [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.28\u20130.98; <jats:italic>P<\/jats:italic> for trend = 0.021]. Furthermore, PD and healthy lifestyle habits were negatively associated with NAFLD (OR = 0.42, 95% CI 0.23\u20130.78; <jats:italic>P<\/jats:italic> for trend = 0.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our data suggest that the PD alone and in combination with lifestyle factors was associated with decreased risk of NAFLD in a significant manner in the overall population. However, prospective studies are needed to further investigate this association.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2022.934845","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T05:31:00Z","timestamp":1658208660000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Adherence to a Paleolithic Diet in Combination With Lifestyle Factors Reduces the Risk for the Presence of Non-Alcoholic Fatty Liver Disease: A Case-Control Study"],"prefix":"10.3389","volume":"9","author":[{"given":"Mohammad Hassan","family":"Sohouli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somaye","family":"Fatahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elma","family":"Izze da Silva Magalh\u00e3es","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Rodrigues de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pejman","family":"Rohani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Ezoddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi Mehdinezhad","family":"Roshan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azita","family":"Hekmatdoost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1038\/nrgastro.2014.232","article-title":"NAFLD in 2014: genetics, diagnostics and therapeutic advances in NAFLD","volume":"12","author":"Rinella","year":"2015","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of non-alcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"B3","first-page":"149","article-title":"Prevalence of non-alcoholic fatty liver disease and its related factors in Iran","volume":"7","author":"Moghaddasifar","year":"2016","journal-title":"Int J Organ Transplant Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"9488","DOI":"10.3748\/wjg.v22.i43.9488","article-title":"Non-alcoholic fatty liver disease - A multisystem disease?","volume":"22","author":"Mikolasevic","year":"2016","journal-title":"World J Gastroenterol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"11124","DOI":"10.1038\/s41598-019-47687-3","article-title":"Non-alcoholic fatty liver disease and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis","volume":"9","author":"Liu","year":"2019","journal-title":"Sci Rep"},{"key":"B6","first-page":"1007","article-title":"Relationship between diet and non-alcoholic fatty liver disease: a review article","volume":"46","author":"Mirmiran","year":"2017","journal-title":"Iran J Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1177\/1756283X17725977","article-title":"Association between physical activity and risk of non-alcoholic fatty liver disease: a meta-analysis","volume":"10","author":"Qiu","year":"2017","journal-title":"Thrapeutic Adv Gastroenterol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1111\/obr.12407","article-title":"Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies","volume":"17","author":"Li","year":"2016","journal-title":"Obes Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2050312117745223","DOI":"10.1177\/2050312117745223","article-title":"Association between smoking and non-alcoholic fatty liver disease: a systematic review and meta-analysis","volume":"6","author":"Akhavan Rezayat","year":"2018","journal-title":"SAGE Open Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1002\/hep.31518","article-title":"Multiple parallel hits hypothesis in non-alcoholic fatty liver disease: revisited after a decade","volume":"73","author":"Tilg","year":"2021","journal-title":"Hepatology."},{"key":"B11","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.jhep.2017.05.016","article-title":"Treatment of NAFLD with diet, physical activity and exercise","volume":"67","author":"Romero-G\u00f3mez","year":"2017","journal-title":"J Hepatol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.jhep.2020.07.045","article-title":"A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement","volume":"73","author":"Eslam","year":"2020","journal-title":"J Hepatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1002\/oby.22964","article-title":"A fad too far? Dietary strategies for the prevention and treatment of NAFLD","volume":"28","author":"Moore","year":"2020","journal-title":"Obesity"},{"key":"B14","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1177\/0884533610385702","article-title":"Paleolithic nutrition: twenty-five years later","volume":"25","author":"Konner","year":"2010","journal-title":"Nutr Clin Pract"},{"key":"B15","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1056\/NEJM198501313120505","article-title":"Paleolithic nutrition. A consideration of its nature and current implications","volume":"312","author":"Eaton","year":"1985","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3390\/diseases5040023","article-title":"An overview of dietary interventions and strategies to optimize the management of non-alcoholic fatty liver disease","volume":"5","author":"Perumpail","year":"2017","journal-title":"Diseases"},{"key":"B17","doi-asserted-by":"publisher","first-page":"612","DOI":"10.3945\/jn.116.241919","article-title":"Paleolithic and Mediterranean diet pattern scores are inversely associated with all-cause and cause-specific mortality in adults","volume":"147","author":"Whalen","year":"2017","journal-title":"J Nutr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1093\/aje\/kwu235","article-title":"Paleolithic and Mediterranean diet pattern scores and risk of incident, sporadic colorectal adenomas","volume":"180","author":"Whalen","year":"2014","journal-title":"Am J Epidemiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3935","DOI":"10.1007\/s00394-021-02565-5","article-title":"The associations of the palaeolithic diet alone and in combination with lifestyle factors with type 2 diabetes and hypertension risks in women in the E3N prospective cohort","volume":"60","author":"Shah","year":"2021","journal-title":"Eur J Nutr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"3018","DOI":"10.1111\/liv.14675","article-title":"MAFLD identifies patients with significant hepatic fibrosis better than NAFLD","volume":"40","author":"Yamamura","year":"2020","journal-title":"Liver Int."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.3390\/cells9041005","article-title":"Non-invasive diagnosis of NAFLD and NASH","volume":"9","author":"Piazzolla","year":"2020","journal-title":"Cells."},{"key":"B22","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1177\/2050640619900820","article-title":"Novel reliability criteria for controlled attenuation parameter assessments for non-invasive evaluation of hepatic steatosis","volume":"8","author":"Semmler","year":"2020","journal-title":"United European Gastroenterol J."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12875-015-0324-8","article-title":"Evaluation of reliability and validity of the general practice physical activity questionnaire (GPPAQ) in 60\u201374 year old primary care patients","volume":"16","author":"Ahmad","year":"2015","journal-title":"BMC Fam Pract."},{"key":"B24","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1017\/S1368980009991698","article-title":"Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study","volume":"13","author":"Mirmiran","year":"2010","journal-title":"Public Health Nutr."},{"key":"B25","first-page":"213","article-title":"The manual for household measures, cooking yields factors and edible portion of foods","volume":"7","author":"Ghaffarpour","year":"1999"},{"key":"B26","first-page":"2003","author":"Bowman","year":"2008","journal-title":"MyPyramid Equivalents Database, 2.0 for USDA survey foods"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1158\/1055-9965.EPI-17-1184","article-title":"Evolutionary-concordance lifestyle and diet and Mediterranean diet pattern scores and risk of incident colorectal cancer in Iowa women","volume":"27","author":"Cheng","year":"2018","journal-title":"Cancer Epidemiol Biomarkers Prev."},{"key":"B28","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1093\/clinchem\/18.6.499","article-title":"Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge","volume":"18","author":"Friedewald","year":"1972","journal-title":"Clin Chem."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.3390\/nu13031019","article-title":"Paleolithic diet-effect on the health status and performance of athletes?","volume":"13","author":"Fraczek","year":"2021","journal-title":"Nutrients"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.3945\/jn.115.224048","article-title":"Paleolithic and Mediterranean diet pattern scores are inversely associated with biomarkers of inflammation and oxidative balance in adults","volume":"146","author":"Whalen","year":"2016","journal-title":"J Nutr"},{"key":"B31","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1017\/S0954422420000153","article-title":"Scoping review of paleolithic dietary patterns: a definition proposal","volume":"34","author":"de la","year":"2021","journal-title":"Nutr Res Rev"},{"key":"B32","doi-asserted-by":"publisher","first-page":"77","DOI":"10.17925\/EE.2019.15.2.77","article-title":"Palaeolithic diet in diabesity and endocrinopathies - a vegan's perspective","volume":"15","author":"Gupta","year":"2019","journal-title":"Eur Endocrinol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1111\/liv.14360","article-title":"The role of nutrition in non-alcoholic fatty liver disease: pathophysiology and management","volume":"1","author":"Bern\u00e1","year":"2020","journal-title":"Liver Int"},{"key":"B34","doi-asserted-by":"publisher","first-page":"35","DOI":"10.34172\/aim.2021.06","article-title":"Association between dietary patterns and non-alcoholic fatty liver disease: results from a case-control study","volume":"24","author":"Tutunchi","year":"2021","journal-title":"Arch Iran Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12876-021-01612-z","article-title":"Dietary patterns and risk of non-alcoholic fatty liver disease","volume":"21","author":"Salehi-Sahlabadi","year":"2021","journal-title":"BMC Gastroenterol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.3390\/nu13051442","article-title":"Overview of non-alcoholic fatty liver disease (NAFLD) and the role of sugary food consumption and other dietary components in its development","volume":"13","author":"Vancells Lujan","year":"2021","journal-title":"Nutrients"},{"key":"B37","doi-asserted-by":"publisher","first-page":"3860","DOI":"10.3390\/nu12123860","article-title":"Nutritional approaches for the management of non-alcoholic fatty liver disease: an evidence-based review","volume":"12","author":"Parra-Vargas","year":"2020","journal-title":"Nutrients"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1016\/j.jhep.2018.01.015","article-title":"High red and processed meat consumption is associated with non-alcoholic fatty liver disease and insulin resistance","volume":"68","author":"Zelber-Sagi","year":"2018","journal-title":"J Hepatol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"359","DOI":"10.15403\/jgld.2014.1121.243.gta","article-title":"Hype or reality: should patients with metabolic syndrome-related NAFLD be on the hunter-gatherer (Paleo) diet to decrease morbidity?","volume":"24","author":"Tarantino","year":"2015","journal-title":"J Gastrointestin Liver Dis."},{"key":"B40","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s12020-019-01982-1","article-title":"Insulin-like growth factor-1 and non-alcoholic fatty liver disease: a systemic review and meta-analysis","volume":"65","author":"Yao","year":"2019","journal-title":"Endocrine."},{"key":"B41","doi-asserted-by":"publisher","first-page":"5227","DOI":"10.3390\/ijerph18105227","article-title":"Non-alcoholic fatty liver disease: metabolic, genetic, epigenetic and environmental risk factors","volume":"18","author":"Juanola","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B42","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s12902-021-00721-w","article-title":"Calcium to magnesium intake ratio and non-alcoholic fatty liver disease development: a case-control study","volume":"21","author":"Emamat","year":"2021","journal-title":"BMC Endocr Disord"},{"key":"B43","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.nut.2018.11.021","article-title":"Dietary patterns are associated with the prevalence of non-alcoholic fatty liver disease in Korean adults","volume":"62","author":"Chung","year":"2019","journal-title":"Nutrition"},{"key":"B44","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.metabol.2017.04.011","article-title":"Non-alcoholic fatty liver disease: a sign of systemic disease","volume":"72","author":"Reccia","year":"2017","journal-title":"Metabolism"},{"key":"B45","doi-asserted-by":"publisher","first-page":"219","DOI":"10.2174\/1570161115666170621075619","article-title":"Is non-alcoholic fatty liver disease indeed the hepatic manifestation of metabolic syndrome?","volume":"16","author":"Katsiki","year":"2018","journal-title":"Curr Vasc Pharmacol"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2022.934845\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T05:31:06Z","timestamp":1658208666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2022.934845\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,19]]},"references-count":45,"alternative-id":["10.3389\/fnut.2022.934845"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2022.934845","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,19]]},"article-number":"934845"}}