{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:48:27Z","timestamp":1791406107273,"version":"4.3.3"},"reference-count":36,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,6,23]],"date-time":"2024-06-23T00:00:00Z","timestamp":1719100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The main objective of this study is to determine the accuracy of different biochemical markers of hepatic steatosis and to correlate liver steatosis with adherence to the Mediterranean diet and level of physical activity. Methods: A cross-sectional study was carried out, including subjects over 50 years of age, with a BMI &gt; 25 kg\/m2, but excluding any patient with documented hepatic pathology other than hepatic steatosis. Participants were divided into two groups: patients with hepatic steatosis diagnosed by ultrasound (SG) and a control group of individuals without hepatic steatosis (CG). The level of physical activity was recorded by the IPAQ-SF questionnaire and the adherence to the Mediterranean diet was recorded using the PREDIMED questionnaire. Biochemical markers analyzed included the Hepatic steatosis index (HSI), AST-to-Platelet ratio (APRI) and Fibrosis-4 (FIB-4). Results: A total of 116 patients were included, 71 belonging to the SG and 45 to the CG. A total of 58.6% of the patients showed low adherence to the Mediterranean diet, 35.4% moderate adherence and 6% high adherence. The median estimated physical activity was 495 METS, with most participants reporting light activity. In the SG, significantly higher HSI values were observed (p &lt; 0.001). A cut-off point of a HSI of 40 was established, with a sensitivity of 73.2% and a specificity of 65.8%. Significantly higher FIB-4 values (p = 0.039) were also observed in the SG. A cut-off point of FIB-4 was set at 0.27, with a sensitivity of 69% and a specificity of 57.9%. Patients in the SG showed lower scores in the PREDIMED. Patients in the SG tended to show lower METS scores. However, the higher number of patients with intense activity in the CG group stands out (p = 0.008). Conclusions: The HSI and FIB-4 showed a significant correlation with liver steatosis. Hepatic steatosis is associated with low adherence to the Mediterranean diet and patients with hepatic steatosis tended to have lower METS scores.<\/jats:p>","DOI":"10.3390\/nu16131996","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T03:53:43Z","timestamp":1719201223000},"page":"1996","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Influence of Adherence to the Mediterranean Diet and Level of Physical Activity with Liver Steatosis in People Aged &gt; 50 Years and with a BMI &gt; 25 kg\/m2: Association with Biochemical Markers"],"prefix":"10.3390","volume":"16","author":[{"given":"Laura","family":"Cano-Lallave","sequence":"first","affiliation":[{"name":"Department of Health Sciences, School of Medicine, Alfonso X University, 28691 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8505-2605","authenticated-orcid":false,"given":"Jaime","family":"Ruiz-Tovar","sequence":"additional","affiliation":[{"name":"San Juan de Dios Foundation, 28015 Madrid, Spain"},{"name":"Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28015 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Martin-de-Bernardo","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Alfonso X University, 28691 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malena","family":"Martinez-Oribe","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Alfonso X University, 28691 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6562-3743","authenticated-orcid":false,"given":"Cristina","family":"Rodriguez-Obispo","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Alfonso X University, 28691 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Carrascosa-Corrochano","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Alfonso X University, 28691 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Mart\u00edn-Nieto","sequence":"additional","affiliation":[{"name":"San Juan de Dios Foundation, 28015 Madrid, Spain"},{"name":"Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28015 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Baeza","sequence":"additional","affiliation":[{"name":"San Juan de Dios Foundation, 28015 Madrid, Spain"},{"name":"Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28015 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Gonzalez-Ramos","sequence":"additional","affiliation":[{"name":"San Juan de Dios Foundation, 28015 Madrid, Spain"},{"name":"Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28015 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Benito","sequence":"additional","affiliation":[{"name":"San Juan de Dios Foundation, 28015 Madrid, Spain"},{"name":"Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28015 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6579-0328","authenticated-orcid":false,"given":"Isabel","family":"Olazabal","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Alfonso X University, 28691 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,23]]},"reference":[{"key":"ref_1","first-page":"2401","article-title":"Hepatopat\u00eda grasa no alcoh\u00f3lica y esteatohepatitis no alcoh\u00f3lica","volume":"Volume 2","author":"Abdelmalek","year":"2018","journal-title":"Harrison Principios De Medicina Interna"},{"key":"ref_2","unstructured":"Flier, J.S., and Maratos-Flier, E. (2018). Biopatolog\u00eda de la obesidad. Harrison Principios De Medicina Interna, McGraw-Hill Education. [20th ed.]."},{"key":"ref_3","first-page":"37","article-title":"Diagn\u00f3stico de esteatosis hep\u00e1tica por m\u00e9todos cl\u00ednicos, bioqu\u00edmicos y por im\u00e1genes","volume":"54","author":"Graffigna","year":"2017","journal-title":"Rev. Argent. Endocrinol. Metab."},{"key":"ref_4","unstructured":"Ruiz-Tovar, J. (2019). Biochemical markers. Liver Steatosis and Bariatric Surgery, Nova Science Publishers, Inc."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2021). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis-2021 update. J. Hepatol., 75, 659\u2013689.","DOI":"10.1016\/j.jhep.2021.05.025"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1016\/j.soard.2019.05.004","article-title":"Validation of biochemical scores for liver steatosis before and 1 year after sleeve gastrectomy","volume":"15","author":"Zubiaga","year":"2019","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_7","first-page":"e2200145","article-title":"Plasma Metabolite Profiles Associated with the Amount and Source of Meat and Fish Consumption and the Risk of Type 2 Diabetes","volume":"10","author":"Nishi","year":"2022","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zapata, I., Mat\u00e9-Mu\u00f1oz, J.L., Higueras, A., Hern\u00e1ndez-Lougedo, J., Mart\u00edn-Fidalgo, N., Garc\u00eda-Fern\u00e1ndez, P., Redondo-Vega, M.V., and Ruiz-Tovar, J. (2022). Toxic habits and well-being measures in Spanish Healthcare University Students during the COVID-19 pandemic. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192013213"},{"key":"ref_9","first-page":"281","article-title":"F\u00f3rmula CUN-BAE y factores bioqu\u00edmicos como marcadores predictivos de obesidad y enfermedad cardiovascular en pacientes pre y post gastrectom\u00eda vertical","volume":"30","author":"Bernal","year":"2014","journal-title":"Nutr. Hosp."},{"key":"ref_10","unstructured":"UCLA (2023, November 28). Statistical Methods and Data Analytics. Available online: https:\/\/stats.oarc.ucla.edu\/other\/gpower\/."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Carre\u00f1o Enciso, L., de Mateo Silleras, B., de la Cruz Marcos, S., and Redondo Del R\u00edo, P. (2024). Social Media for Nutrition Education-A Randomized Controlled Trial to Promote Fruit and Vegetable Intake in a University Setting: \u201cThe University of Valladolid Community Eats Healthy\u201d Study. Nutrients, 16.","DOI":"10.3390\/nu16091308"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102679","DOI":"10.1016\/j.psychsport.2024.102679","article-title":"Greater weekly physical activity linked to left resting frontal alpha asymmetry in women: A study on gender differences in highly active young adults","volume":"74","author":"Wilhelm","year":"2024","journal-title":"Psychol. Sport Exerc."},{"key":"ref_13","doi-asserted-by":"crossref","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":"ref_14","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1056\/NEJMoa1800389","article-title":"Primary prevention of cardiovascular disease with a Mediterranean diet","volume":"378","author":"Estruch","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s11136-012-0219-2","article-title":"Health-related quality of life of Greek adolescents: The role of the Mediterranean diet","volume":"22","author":"Costarelli","year":"2013","journal-title":"Qual. Life Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s12603-010-0091-0","article-title":"Urban environment, physical inactivity and unhealthy dietary habits correlate to depression among elderly livingin Eastern Mediterranean Islands: The MEDIS (Mediterranean Islands Elderly) study","volume":"14","author":"Mamplekou","year":"2010","journal-title":"J. Nutr. Health Aging"},{"key":"ref_17","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_18","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1001\/archinternmed.2009.38","article-title":"A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease","volume":"169","author":"Mente","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1402S","DOI":"10.1093\/ajcn\/61.6.1402S","article-title":"Mediterranean diet pyramid: A cultural model for healthy eating","volume":"61","author":"Willett","year":"1995","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1093\/gerona\/glx227","article-title":"Health benefits of the Mediterranean diet: Metabolic and molecular mechanisms","volume":"73","author":"Tosti","year":"2018","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1017\/S1368980016003177","article-title":"Med Diet 4.0: The Mediterranean diet with four sustainable benefits","volume":"20","author":"Dernini","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s00394-002-0382-2","article-title":"Determinants of the adherence to an \u201ca priori\u201d defined Mediterranean dietary pattern","volume":"41","author":"Martinez","year":"2002","journal-title":"Eur. J. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1007\/s00431-012-1735-3","article-title":"Correlation of blood pressure, obesity and adherence to the Mediterranean diet with indices of arterial stiffness in children","volume":"171","author":"Lydakis","year":"2012","journal-title":"Eur. J. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","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":"ref_25","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/MCO.0000000000000071","article-title":"The Mediterranean diet, hepatic steatosis and nonalcoholic fatty liver disease","volume":"17","author":"Velasco","year":"2014","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Karkovi\u0107 Markovi\u0107, A., Tori\u0107, J., Barbari\u0107, M., and Jakobu\u0161i\u0107 Brala, C. (2019). Hydroxytyrosol, tyrosol and derivatives and their potential effects on human health. Molecules, 24.","DOI":"10.3390\/molecules24102001"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1111\/bcp.13589","article-title":"Oleuropein, a component of extra virgin olive oil, lowers postprandial glycaemia in healthy subjects","volume":"84","author":"Carnevale","year":"2018","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5035","DOI":"10.1021\/acs.biochem.7b00199","article-title":"Olive component oleuropein promotes \u03b2-cell insulin secretion and protects \u03b2-cells from amylin amyloid-induced cytotoxicity","volume":"56","author":"Wu","year":"2017","journal-title":"Biochemistry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1080\/09637486.2016.1214239","article-title":"Mediterranean diet and nonalcoholic fatty liver disease: Molecular mechanisms of protection","volume":"68","author":"Godos","year":"2017","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.gastrohep.2021.06.006","article-title":"Effect of the Mediterranean diet on histological indicators and imaging tests in non-alcoholic fatty liver disease","volume":"45","author":"Saavedra","year":"2022","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"174051","DOI":"10.1016\/j.scitotenv.2024.174051","article-title":"Exploring dietary patterns and their association with environmental sustainability and body mass index in children and adolescents: Insights from the National Food, nutrition and physical activity survey 2015\u20132016","volume":"15","author":"Teixeira","year":"2024","journal-title":"Sci. Total Environ."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1042\/CS20150308","article-title":"Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials","volume":"129","author":"Hallsworth","year":"2015","journal-title":"Clin. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"12137","DOI":"10.1038\/s41598-024-62677-w","article-title":"Evaluating the impact of exercise on intermediate disease markers in overweight and obese individuals through a network meta-analysis of randomized controlled trials","volume":"14","author":"Liu","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.ajcnut.2024.02.021","article-title":"Effect of 1-year lifestyle intervention with energy-reduced Mediterranean diet and physical activity promotion on the gut metabolome and microbiota: A randomized clinical trial","volume":"119","author":"Atzeni","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"6571","DOI":"10.3748\/wjg.v23.i36.6571","article-title":"Nonalcoholic fatty liver disease: Evolving paradigms","volume":"23","author":"Lonardo","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"899","DOI":"10.5604\/01.3001.0012.7188","article-title":"The evolving role of liver biopsy in nonalcoholic fatty liver disease","volume":"17","author":"Arab","year":"2018","journal-title":"Ann. Hepatol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/13\/1996\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:03:12Z","timestamp":1760108592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/13\/1996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,23]]},"references-count":36,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["nu16131996"],"URL":"https:\/\/doi.org\/10.3390\/nu16131996","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,23]]}}}