Intestinal permeability after Mediterranean diet and low-fat diet in non-alcoholic fatty liver disease

Marco Biolato, Fiorella Manca, Giuseppe Marrone, Consuelo Cefalo, Simona Racco, Giacinto A Miggiano, Venanzio Valenza, Antonio Gasbarrini, Luca Miele, Antonio Grieco

Research output: Contribution to journalArticlepeer-review


BACKGROUND: In non-alcoholic fatty liver disease (NAFLD), a high-fat or high-fructose diet increases intestinal permeability and promotes derangement of the gut-liver axis. We hypothesize that, diet could be able to modulate intestinal permeability in patients with NAFLD.

AIM: To detect diet-induced modification of intestinal permeability in patients with NAFLD undergoing a Mediterranean diet or a low-fat diet.

METHODS: The current study was a dietary intervention for non-diabetic, patients with biopsy-verified NAFLD and increased transaminases. A crossover design was employed: participants underwent 16 weeks of Mediterranean diet, 16 wk of free wash-out, and 16 weeks of low-fat diet. Both diets were hypocaloric and no consumption of supplements was allowed. All patients were followed bimonthly by a dietitian. Evaluations of clinical and metabolic parameters were completed at baseline and at the end of each dietary period. Intestinal permeability was assessed by chromium-51 ethylene diamine tetraacetate excretion testing (51Cr-EDTA).

RESULTS: Twenty Caucasian patients, 90% male, median age 43 years, body mass index (BMI) 30.9, with biopsy-verified NAFLD were enrolled. At the end of 16 weeks of a Mediterranean diet, a significant reduction in mean body weight (-5.3 ± 4.1 kg, P = 0.003), mean waist circumference (-7.9 ± 4.9 cm, P = 0.001), and mean transaminase levels [alanine aminotransferase (ALT) -28.3 ± 11.9 IU/L, P = 0.0001; aspartate aminotransferase (AST) -6.4 ± 56.3 IU/L, P = 0.01] were observed. These benefits were maintained after 16 wk of wash-out and also after 16 wk of low-fat diet, without further improvements. Fourteen of the 20 patients had intestinal permeability alteration at baseline (mean percentage retention of 51Cr-EDTA = 5.4%), but no significant changes in intestinal permeability were observed at the end of the 16 wk of the Mediterranean diet or 16 wk of the low-fat diet.

CONCLUSION: Mediterranean diet is an effective strategy for treating overweight, visceral obesity and serum transaminase in patients with NAFLD. If the Mediterranean diet can improve intestinal permeability in patients with NAFLD, it deserves further investigation.

Original languageEnglish
Pages (from-to)509-520
Number of pages12
JournalWorld Journal of Gastroenterology
Issue number4
Publication statusPublished - Jan 28 2019


  • Adult
  • Body Mass Index
  • Body Weight
  • Chromium Radioisotopes/chemistry
  • Cross-Over Studies
  • Diet, Fat-Restricted
  • Diet, Mediterranean
  • Edetic Acid/chemistry
  • Female
  • Humans
  • Intestinal Mucosa/metabolism
  • Male
  • Non-alcoholic Fatty Liver Disease/diet therapy
  • Overweight/diet therapy
  • Permeability
  • Prospective Studies
  • Treatment Outcome
  • Waist Circumference


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