Objective: The study investigated the association between markers of liver steatosis and fibrosis and the adherence to the Mediterranean dietary pattern, evaluated by a diet-quality score, in patients with type 2 diabetes (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods: Patients with T2DM and MASLD underwent a comprehensive medical evaluation, which included lifestyle, clinical, laboratory, and liver ultrasound assessment. The natural consumption of foods specific to the Mediterranean Diet (MedDiet) was investigated by a previously validated 14-item questionnaire (MedDiet Score). For the estimation of liver steatosis, the Index of NASH (Non-alcoholic steatohepatitis) (ION) was calculated by sex-specific formulas, while liver fibrosis was estimated by the Fibrosis-4 (FIB-4) score.
Results: Data from 271 patients were analyzed. The mean MedDiet Score was 4.55±1.59 points, and most patients scored 3 points (19.93%), 4 points (28.78%), and 5 points (21.40%). Patients with a MedDiet Score ≥5 points had lower fasting blood glucose, ferritin, C-peptide and HOMA-IR, and lower ION values (19.96 ±14.63 vs. 23.50±14.77; p=0.025). No significant differences were noted for FIB-4 values. MedDiet Score was negatively correlated with fasting blood glucose, ferritin, C-peptide, HOMA-IR, and ION values (r=-0.14 [-0.25; -0.01]; p=0.026), and positively with LDL cholesterol levels. Drinking less than one portion of sweet or carbonated beverages daily and eating at least 3 portions of nuts weekly was associated with lower ION values.
Conclusions: Low MedDiet Score was associated with markers of hepatic steatosis (but not fibrosis), worse insulin resistance, higher fasting hyperglycemia, and serum ferritin levels in patients with T2DM and MASLD.