{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T12:10:30Z","timestamp":1781179830713,"version":"3.54.1"},"reference-count":45,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health with Ricerca Corrente 2021"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The gold standard treatment for NAFLD is weight loss and lifestyle interventions, which require a diet enriched in fiber and reduced in sugars and saturated fats. Fibres may be advantageous for NAFLD patients since they reduce and slow the absorption of carbohydrates, lipids, and proteins, lowering the energy density of the meal and increasing their sense of satiety. Furthermore, the polyphenol content and other bioactive compounds of vegetables have antioxidant and anti-inflammatory properties preventing disease progression. The aim of this study is to ascertain the effects of a diet enriched by green leafy vegetables and with a moderate restriction of carbohydrate intake in patients with NAFLD over a three month period. Among the forty patients screened, twenty four patients completed the clinical trial consisting of swapping one portion of carbohydrate-rich food for one portion of green leafy vegetables, and liver and metabolic markers of NAFLD were evaluated. All patients underwent routine blood tests, anthropometric measurements, bioelectrical impedance analysis, fibroscan, and fatty liver index (FLI) evaluation before and at the end of the study. The population under study (n = 24) had a median age of 47.5 (41.5\u201352.5) years and included mainly women (70.8%). We found that FLI, which is used to predict fatty liver (73 (33\u201389) vs. 85 (54\u201395), p &lt; 0.0001) and the FAST score, which is a fibroscan-derived parameter identifying patients at risk of progressive NASH (0.03 (0.02\u20130.09) vs. 0.05 (0.02\u20130.15), p = 0.007), were both improved after changes in diet. The BMI (33.3 (28.6\u201337.3) vs. 35.3 (31.2\u201339.0), p &lt; 0.0001), WC (106.5 (95.0\u2013112.5) vs. 110.0 (103.0\u2013124.0), p &lt; 0.0001), neck circumference (38.0 (35.0\u201341.5) vs. 39.5 (38.0\u201342.5), p &lt; 0.0001), fat mass (32.3 (23.4\u201340.7) vs. 37.9 (27.7\u201343.5), p &lt; 0.0001), and extracellular water (17.3 (15.2\u201320.8) vs. 18.3 (15.9\u201322.7), p = 0.03) were also all significantly lower after three months of diet. Metabolic parameters linked to NAFLD decreased: HbA1c (36.0 (33.5\u201339.0) vs. 38.0 (34.0\u201340.5), p = 0.01), triglycerides (72 (62\u201390) vs. 90 (64\u2013132), p = 0.03), and the liver markers AST (17 (14\u201319) vs. 18 (15\u201327), p = 0.01) and \u03b3GT (16 (13\u201320) vs. 16 (14\u201327), p = 0.02). In conclusion, replacing only one portion of starchy carbohydrates with one portion of vegetables for a three month period is sufficient to regress, at least in part, both mid and advanced stages of NAFLD. This moderate adjustment of lifestyle habits is easily achievable.<\/jats:p>","DOI":"10.3390\/nu15102289","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T09:26:13Z","timestamp":1683883573000},"page":"2289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Replacement of Only One Portion of Starchy Carbohydrates with Green Leafy Vegetables Regresses Mid and Advanced Stages of NAFLD: Results from a Prospective Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Sara","family":"De Nucci","sequence":"first","affiliation":[{"name":"Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3817-8643","authenticated-orcid":false,"given":"Roberta","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Di Chito","sequence":"additional","affiliation":[{"name":"Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9140-673X","authenticated-orcid":false,"given":"Rossella","family":"Donghia","sequence":"additional","affiliation":[{"name":"Unit of Data Science, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Giannuzzi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4909-0436","authenticated-orcid":false,"given":"Endrit","family":"Shahini","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Cozzolongo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4675-2075","authenticated-orcid":false,"given":"Pasqua Letizia","family":"Pesole","sequence":"additional","affiliation":[{"name":"National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Coletta","sequence":"additional","affiliation":[{"name":"National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"De Pergola","sequence":"additional","affiliation":[{"name":"Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-8060","authenticated-orcid":false,"given":"Gianluigi","family":"Giannelli","sequence":"additional","affiliation":[{"name":"Scientific Direction, National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, Via Turi 27, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Le, M.H., Yeo, Y.H., Li, X., Li, J., Zou, B., Wu, Y., Ye, Q., Huang, D.Q., Zhao, C., and Zhang, J. (2021). 2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis. Clin. Gastroenterol. Hepatol., 20.","DOI":"10.1016\/j.cgh.2021.12.002"},{"key":"ref_2","first-page":"851","article-title":"The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","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":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7006","DOI":"10.3748\/wjg.v22.i31.7006","article-title":"Metabolic aspects of adult patients with nonalcoholic fatty liver disease","volume":"22","author":"Abenavoli","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","article-title":"Non-alcoholic fatty liver disease","volume":"397","author":"Powell","year":"2021","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1111\/apt.16016","article-title":"Patterns and predictors of mortality and disease progression among patients with non-alcoholic fatty liver disease","volume":"52","author":"Canbay","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/j.jhep.2015.11.004","article-title":"EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease","volume":"64","author":"Marchesini","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"a1344","DOI":"10.1136\/bmj.a1344","article-title":"Adherence to Mediterranean diet and health status: Meta-analysis","volume":"337","author":"Sofi","year":"2008","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"D\u2019Alessandro, A., Lampignano, L., and De Pergola, G. (2019). Mediterranean Diet Pyramid: A Proposal for Italian People. A Systematic Review of Prospective Studies to Derive Serving Sizes. Nutrients, 11.","DOI":"10.3390\/nu11061296"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E2599","DOI":"10.1210\/jc.2014-2302","article-title":"Modulation of Amino Acid Metabolic Signatures by Supplemented Isoenergetic Diets Differing in Protein and Cereal Fiber Content","volume":"99","author":"Hattersley","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Plaz Torres, M.C., Aghemo, A., Lleo, A., Bodini, G., Furnari, M., Marabotto, E., Miele, L., and Giannini, E.G. (2019). Mediterranean Diet and NAFLD: What We Know and Questions That Still Need to Be Answered. Nutrients, 11.","DOI":"10.3390\/nu11122971"},{"key":"ref_13","doi-asserted-by":"crossref","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":"ref_14","doi-asserted-by":"crossref","unstructured":"Raiola, A., Errico, A., Petruk, G., Monti, D.M., Barone, A., and Rigano, M.M. (2017). Bioactive Compounds in Brassicaceae Vegetables with a Role in the Prevention of Chronic Diseases. Molecules, 23.","DOI":"10.3390\/molecules23010015"},{"key":"ref_15","doi-asserted-by":"crossref","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":"ref_16","doi-asserted-by":"crossref","first-page":"e13659","DOI":"10.1111\/eci.13659","article-title":"Is there an \u2018ideal\u2019 diet for patients with NAFLD?","volume":"52","author":"Pugliese","year":"2022","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jshs.2019.03.007","article-title":"New scientific basis for the 2018 U.S. Physical Activity Guidelines","volume":"8","author":"DiPietro","year":"2019","journal-title":"J. Sport Health Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.numecd.2008.10.007","article-title":"Adherence to the Mediterranean diet and risk of metabolic syndrome and its components","volume":"19","author":"Babio","year":"2016","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8348","DOI":"10.1039\/D2FO01488B","article-title":"Are isothiocyanates and polyphenols from Brassicaceae vegetables emerging as preventive\/therapeutic strategies for NAFLD? The landscape of recent preclinical findings","volume":"13","author":"Bacil","year":"2022","journal-title":"Food Funct."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1016\/j.ultrasmedbio.2018.07.008","article-title":"Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations","volume":"44","author":"Ferraioli","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/S2468-1253(19)30383-8","article-title":"FibroScan-AST (FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: A prospective derivation and global validation study","volume":"5","author":"Newsome","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wu, J., Tian, S., Li, H., Xu, Z., Li, S., Chen, Y.-L., Liang, X.-Y., Xiao, J., Song, J.-Y., and She, R.-L. (2022). Population-specific cut-off points of fatty liver index: A study based on the National Health and Nutrition Examination Survey data. BMC Gastroenterol., 22.","DOI":"10.1186\/s12876-022-02303-z"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.clnesp.2019.09.012","article-title":"Equation models developed with bioelectric impedance analysis tools to assess muscle mass: A systematic review","volume":"35","author":"Beaudart","year":"2020","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1038\/s41430-018-0335-3","article-title":"Bioelectrical impedance analysis for body composition assessment: Reflections on accuracy, clinical utility, and standardization","volume":"73","author":"Ward","year":"2019","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/clinchem\/36.1.15","article-title":"Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints","volume":"36","author":"Warnick","year":"1990","journal-title":"Clin. Chem."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"380","DOI":"10.5582\/ddt.2015.01207","article-title":"Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future","volume":"9","author":"Tang","year":"2015","journal-title":"Drug Discov. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/MCO.0000000000000914","article-title":"Nutritional regulation of hepatic de novo lipogenesis in humans","volume":"26","author":"Cross","year":"2023","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e150996","DOI":"10.1172\/JCI150996","article-title":"Dietary sugar restriction reduces hepatic de novo lipogenesis in adolescent boys with fatty liver disease","volume":"131","author":"Cohen","year":"2021","journal-title":"J. Clin. Investig."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1017\/S0954422421000202","article-title":"Carbohydrates deteriorate fatty liver by activating the inflammatory response","volume":"35","author":"Gao","year":"2022","journal-title":"Nutr. Res. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1016\/j.numecd.2021.01.009","article-title":"Does a high intake of green leafy vegetables protect from NAFLD? Evidence from a large population study","volume":"31","author":"Li","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kabisch, S., B\u00e4ther, S., Dambeck, U., Kemper, M., Gerbracht, C., Honsek, C., Sachno, A., and Pfeiffer, A.F.H. (2018). Liver Fat Scores Moderately Reflect Interventional Changes in Liver Fat Content by a Low-Fat Diet but Not by a Low-Carb Diet. Nutrients, 10.","DOI":"10.3390\/nu10020157"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1111\/liv.13488","article-title":"NAFLD in clinical practice: Can simple blood and anthropometric markers be used to detect change in liver fat measured by 1H-MRS?","volume":"37","author":"Keating","year":"2017","journal-title":"Liver Int."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Du, L.-J., He, Z.-Y., Gu, X., Hu, X., Zhang, X.X., Yang, L.-J., Li, J., Pan, L.-Y., Li, Y.-Q., and Yang, B. (2022). Inverse Association of Fruit and Vegetable Consumption with Nonalcoholic Fatty Liver Disease in Chinese Patients with Type 2 Diabetes Mellitus. Nutrients, 14.","DOI":"10.3390\/nu14214559"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"593735","DOI":"10.3389\/fnut.2020.593735","article-title":"Association between Dietary Fiber Intake and Non-alcoholic Fatty Liver Disease in Adults","volume":"7","author":"Zhao","year":"2020","journal-title":"Front. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"12951","DOI":"10.1038\/srep12951","article-title":"Greater serum carotenoid levels associated with lower prevalence of nonalcoholic fatty liver disease in Chinese adults","volume":"5","author":"Cao","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.nut.2017.01.009","article-title":"Effect of magnesium supplementation on insulin resistance in humans: A systematic review","volume":"38","author":"Morais","year":"2017","journal-title":"Nutrition"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1017\/S1368980018000642","article-title":"Intakes of magnesium, calcium and risk of fatty liver disease and prediabetes","volume":"21","author":"Li","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_39","first-page":"483","article-title":"Impact of a low-carbohydrate and high-fiber diet on nonalcoholic fatty liver disease","volume":"29","author":"Chen","year":"2020","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.pcd.2015.12.004","article-title":"Consumption of citrus and cruciferous vegetables with incident type 2 diabetes mellitus based on a meta-analysis of prospective study","volume":"10","author":"Jia","year":"2016","journal-title":"Prim. Care Diabetes"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Trautwein, E.A., and McKay, S. (2020). The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients, 12.","DOI":"10.3390\/nu12092671"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"786","DOI":"10.7326\/M20-0336","article-title":"Associations between Dietary Patterns and Subclinical Cardiac Injury: An Observational Analysis from the DASH Trial","volume":"172","author":"Juraschek","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3198","DOI":"10.1002\/ehf2.14019","article-title":"Higher BNP\/NT-pro BNP levels stratify prognosis equally well in patients with and without heart failure: A meta-analysis","volume":"9","author":"Hendricks","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1046\/j.1365-2265.2003.01836.x","article-title":"Clinical Endocrinology The effect of body weight and weight loss on thyroid volume and function in obese women","volume":"59","author":"Sari","year":"2003","journal-title":"Clin. Endocrinol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1159\/000129678","article-title":"Thyroid hormones and their relation to weight status","volume":"70","author":"Reinehr","year":"2008","journal-title":"Horm. Res. Paediatr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/10\/2289\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:33:56Z","timestamp":1760124836000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/10\/2289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,12]]},"references-count":45,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["nu15102289"],"URL":"https:\/\/doi.org\/10.3390\/nu15102289","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,12]]}}}