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Both the Mediterranean diet (MeD) and the Dietary Approach to Stop Hypertension (DASH) had an inverse association with developing non-alcoholic fatty liver disease (NAFLD), particularly among women, Iranian researchers found.

In an analysis involving over 3,000 adults, those who followed DASH and MeD the closest -- with the highest tertiles of adherence -- had the lowest NAFLD risk (OR 0.80 for DASH, 95% CI 0.66-0.96, P=0.02 for trend; OR 0.64 for MeD, 95% CI 0.52-0.78, P=0.002 for trend), reported Farhad Zamani, MD, of the Iran University of Medical Sciences in Tehran, and colleagues.

Stratified analyses showed a stronger association among women (OR 0.42 for MeD, 95% CI 0.29-0.61, P=0.004 for trend; OR 0.72 for DASH, 95% CI 0.53-0.98, P=0.05 for trend), but no significant association among men, the authors wrote in .

"The rationale for why the relationship was significant only among women could be attributed to an increased willingness to adopt a healthy diet," they noted. "In our study, female participants, compared to males, independent of energy intake, had a greater consumption of fruits, vegetables, and lower dairy products, animal protein, and sweetened beverages."

NAFLD can cause chronic liver diseases, such as non-alcoholic steatohepatitis (NASH) or even cirrhosis and has a worldwide prevalence of approximately 25%, Zamani's group noted. It remains a risk factor for heart disease and is a common indication for liver transplants. The American Heart Association has recommended both MeD and DASH diets for limiting cholesterol. Prior reports have also shown that limited or no access to nutritious foods have led to more deaths among adults with NAFLD.

While discouraging the consumption of red meat and processed foods, DASH focuses on "low-glycemic index and low-energy dense" foods that lower hypertension and improve other chronic conditions such as metabolic syndrome, the authors noted. The MeD, a top diet for 2022, focuses on a high consumption of legumes, whole grains, fruits, and vegetables, which also lowers the risk for chronic diseases.

For their study, Zamani and colleagues examined data on 3,220 adults in Iran from 2016 to 2017. It included participants enrolled in this second phase of the multi-center , who also completed a validated food frequency questionnaire, which measured their typical dietary intake. Abdominal sonography was used to confirm the presence of NAFLD and its severity.

Overall, 55% were men, 55% did not have NAFLD and mean age was 47. Men had a significantly higher total energy intake than women, the authors added.

They found that women had higher BMI, and higher rates of diabetes, metabolic syndrome, use of lipid-lowering agents and hypertension than men. Total cholesterol, HDL, and HbA1C levels were also lower, and women also had a lower rate of alcohol consumption, smoking, heart disease, and physical activity level.

After adjustment, women had significantly higher DASH and significantly lower MeD scores. Non-NAFLD patients also had a significantly higher MeD score versus NAFLD patients, the authors added.

They acknowledged several limitations to the data, including the study's cross-sectional design. Liver biopsies were not performed to evaluate NAFLD severity. In addition to potential confounders, questionnaires introduced recall bias and could contain errors in reporting food intake.

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