Funded in part by California Walnut Commission, California Walnuts Commission
Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial
Yaskolka Meir A, Rinott E, Tsaban G, Zelicha H, Kaplan A, Rosen P, Shelef I, Youngster I, Shalev A, Blüher M, Ceglarek U, Stumvoll M, Tuohy K, Diotallevi C, Vrhovsek U, Hu F, Stampfer M, Shai I
Gut · 210 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
- Intake measured by
- Not stated
Who paid for it
- Funding
- Industry funded
- Government
- Joint Programming Initiative A healthy diet for a healthy life
- Industry group
- California Walnut Commission
- Government
- European Commission
- Government
- Deutsche Forschungsgemeinschaft
- University or hospital
- Ben-Gurion University of the Negev
- Government
- ERA-Net Cofund ERA-HDHL “Biomarkers for Nutrition and Health implementing the JPI HDHL objectives”
- Government
- European Union’s Horizon2020 research and innovation
- Government
- Israel Ministry of Science and Technology
- Government
- the Deutsche Forschungsgemeinschaft
- Industry group
- California Walnuts Commission
- Government
- Israel Ministry of Health
- Authors
- At least one author declares a financial tie to industry
- Grants
- Deutsche Forschungsgemeinschaft (SFB 1052); Deutsche Forschungsgemeinschaft (209933838); California Walnut Commission (87472511); European Commission (696295); Deutsche Forschungsgemeinschaft (SFB-1052/B11); California Walnut Commission (209933838); Deutsche Forschungsgemeinschaft (grant SFB1052); California Walnut Commission (SFB-1052/B11); Deutsche Forschungsgemeinschaft (87472511); Joint Programming Initiative A healthy diet for a healthy life (696295); California Walnut Commission (3-13604); Deutsche Forschungsgemeinschaft (3-13604); California Walnut Commission (SFB1052); European Commission (209933838)
Based on 11 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2021-01-18 · Gut · vol. 70 · issue 11 · pp. 2085–2095
- Publisher
- BMJ
- Cited
- 284 citations · more than 100% of similar papers · 25.9× the field average
- Impact
- Top 10% most cited in its field
- References
- 52 works
- Access
- Open access (hybrid journal) · CC-BY-NC
- Research areas
- Agriculture Sustainability and Environmental Impact · Nutritional Studies and Diet · Animal Nutrition and Physiology
- Keywords
- Fatty liver, Weight loss, Medicine, Animal science, Obesity, Internal medicine, Polyphenol, Body mass index, Gastroenterology, Surgery, Biology, Disease, Biochemistry, Antioxidant
- MeSH
- humans, araceae, diet, reducing, diet, mediterranean, tea, middle aged, female, male, polyphenols, non-alcoholic fatty liver disease
18 authors
From IL, DE, IT, US
- Anat Yaskolka MeirBen-Gurion University of the Negev
- Ehud RinottBen-Gurion University of the Negev
- Gal TsabanBen-Gurion University of the Negev; Soroka Medical Center
- Hila ZelichaBen-Gurion University of the Negev
- Alon KaplanBen-Gurion University of the Negev
- Philip RosenSoroka Medical Center
Abstract
Objective
To examine the effectiveness of green-Mediterranean (MED) diet, further restricted in red/processed meat, and enriched with green plants and polyphenols on non-alcoholic fatty liver disease (NAFLD), reflected by intrahepatic fat (IHF) loss.
Design
For the DIRECT-PLUS 18-month randomized clinical trial, we assigned 294 participants with abdominal obesity/dyslipidaemia into healthy dietary guidelines (HDG), MED and green-MED weight-loss diet groups, all accompanied by physical activity. Both isocaloric MED groups consumed 28 g/day walnuts (+440 mg/day polyphenols provided). The green-MED group further consumed green tea (3-4 cups/day) and Mankai (a Wolffia globosa aquatic plant strain; 100 g/day frozen cubes) green shake (+1240 mg/day total polyphenols provided). IHF% 18-month changes were quantified continuously by proton magnetic resonance spectroscopy (MRS).
Results
Participants (age=51 years; 88% men; body mass index=31.3 kg/m2; median IHF%=6.6%; mean=10.2%; 62% with NAFLD) had 89.8% 18-month retention-rate, and 78% had eligible follow-up MRS. Overall, NAFLD prevalence declined to: 54.8% (HDG), 47.9% (MED) and 31.5% (green-MED), p=0.012 between groups. Despite similar moderate weight-loss in both MED groups, green-MED group achieved almost double IHF% loss (-38.9% proportionally), as compared with MED (-19.6% proportionally; p=0.035 weight loss adjusted) and HDG (-12.2% proportionally; pNaringenin and 2-5-dihydroxybenzoic-acid in green-MED. Greater IHF% loss was independently associated with increased Mankai and walnuts intake, decreased red/processed meat consumption, improved serum folate and adipokines/lipids biomarkers, changes in microbiome composition (beta-diversity) and specific bacteria (p<0.05 for all).
Conclusion
The new suggested strategy of green-Mediterranean diet, amplified with green plant-based proteins/polyphenols as Mankai, green tea, and walnuts, and restricted in red/processed meat can double IHF loss than other healthy nutritional strategies and reduce NAFLD in half.
Trial registration number
NCT03020186.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
Community trust
Loading…
How much do you trust this study's findings?
Comments
Sign in to rate, comment on or flag this study.Sign inSomething wrong here?
Flag this study if its information, labels or funding look wrong. An editor reviews every flag.
Sign in to rate, comment on or flag this study.Sign inEducational information about published research. Not medical advice, and not a recommendation to start or stop anything.