Effects of a multifactorial ecosustainable isocaloric diet on liver fat in patients with type 2 diabetes: Randomized clinical trial

Giuseppe Della Pepa, Claudia Vetrani, Valentina Brancato, Marilena Vitale, Serena Monti, Giovanni Annuzzi, Gianluca Lombardi, Anna Izzo, Marianna Tommasone, Paola Cipriano, Gennaro Clemente, Peppino Mirabelli, Marcello Mancini, Marco Salvatore, Gabriele Riccardi, Angela Albarosa Rivellese, Lutgarda Bozzetto

Research output: Contribution to journalArticlepeer-review


Introduction Treatment options for non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2D) are still a matter of debate. We compared the effects of a diet including different components versus a proven beneficial diet rich in monounsaturated fatty acids (MUFAs) on liver fat in T2D. Research design and methods According to a parallel design, 49 individuals with T2D, overweight/obese, with high waist circumference, 35-75 years-old, in satisfactory blood glucose control with diet or drugs not affecting liver fat content, were randomly assigned to an 8-week isocaloric intervention with a MUFA diet (n=26) or a multifactorial diet rich in fiber, MUFA, n-6 and n-3 polyunsaturated fatty acids, polyphenols, and vitamins D, E, and C (n=23). Before and after the intervention, liver fat content was evaluated by proton magnetic resonance spectroscopy (1 H-MRS). 1 H-MRS complete data were available for n=21 (MUFA diet) and n=18 (multifactorial diet) participants. Results Adherence to dietary interventions was optimal. No significant differences between groups in body weight reduction, plasma glycated hemoglobin, insulin, glucose, lipids and liver enzymes were observed. Liver fat significantly decreased after both the multifactorial diet (9.18%±7.78% vs 5.22%±4.80%, p=0.003) and the MUFA diet (9.47%±8.89% vs 8.07%±8.52%, p=0.027) with a statistically significant difference between changes either in absolute terms (-4.0%±4.5% vs -1.4%±2.7%, p=0.035) or percent (-40%±33% vs -19%±25%, p=0.030). Conclusions An isocaloric multifactorial diet including several beneficial dietary components induced a clinically relevant reduction of liver fat in patients with T2D, more pronounced than that induced by simply replacing saturated fat with MUFA. This suggests that the 'optimal diet' for NAFLD treatment in T2D should be based on synergic actions of different dietary components on multiple pathophysiological pathways. Trial registration number NCT03380416.

Original languageEnglish
Article numbere001342
JournalBMJ Open Diabetes Research and Care
Issue number1
Publication statusPublished - May 24 2020


  • dietary intervention
  • liver fat
  • type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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