The effect of three mediterranean diets on remnant cholesterol and non-alcoholic fatty liver disease: A secondary analysis

Angelo Campanella, Palma A. Iacovazzi, Giovanni Misciagna, Caterina Bonfiglio, Antonella Mirizzi, Isabella Franco, Antonella Bianco, Paolo Sorino, Maria G. Caruso, Anna M. Cisternino, Claudia Buongiorno, Rosalba Liuzzi, Alberto R. Osella

Research output: Contribution to journalArticlepeer-review


Background: Elevated fasting remnant cholesterol (REM-C) levels have been associated with an increased cardiovascular risk in patients with metabolic syndrome (Mets) and Non-Alcoholic Fatty Liver Disease (NAFLD). We aimed to estimate the effect of different diets on REM-C levels in patients with MetS, as well as the association between NAFLD and REM-C. Methods: This is a secondary analysis of the MEDIDIET study, a parallel-arm Randomized Clinical Trial (RCT). We examined 237 people with MetS who underwent Liver Ultrasound (LUS) to assess the NAFLD score at baseline, 3-, and 6-months follow-up. Subjects were randomly assigned to the Mediterranean diet (MD), Low Glycemic Index diet (LGID), or Low Glycemic Index Mediterranean diet (LGIMD). REM-C was calculated as [total cholesterol–low density lipoprotein cholesterol (LDL-C)–high density lipoprotein cholesterol (HDL-C)]. Results: REM-C levels were higher in subjects with moderate or severe NAFLD than in mild or absent ones. All diets had a direct effect in lowering the levels of REM-C after 3 and 6 months of intervention. In adherents subjects, this effect was stronger among LGIMD as compared to the control group. There was also a significant increase in REM-C levels among Severe NAFLD subjects at 3 months and a decrease at 6 months. Conclusions: fasting REM-C level is independently associated with the grade of severity of NAFLD. LGIMD adherence directly reduced the fasting REM-C in patients with MetS.

Original languageEnglish
Article number1674
Pages (from-to)1-16
Number of pages16
Issue number6
Publication statusPublished - Jun 2020


  • Fasting REM-C levels
  • Insulin resistance
  • NAFLD severity score

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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