Green Mediterranean Diet tied to significant reduction of NAFLD: DIRECT-PLUS Trial

The DIRECT PLUS trial was an open-label, randomized trial of 294 participants with abdominal obesity/dyslipidaemia. Researchers assigned them to receive healthy dietary guidelines (HDG), MED and green-MED weight-loss diet groups, all accompanied by physical activity. Both MED groups consumed 28 g walnuts per day; the green-MED group consumed green tea and Mankai (a Wolffia globosa aquatic plant strain) green shake. They used proton magnetic resonance spectroscopy (MRS) to quantify the IHF% changes.

Key findings of the study were:

• Upon analysis, researchers observed a drop in the prevalence of NAFLD to 54.8, 47.9, and 31.5 per cent with HDG, MED, and green-MED, respectively.

• Despite similar moderate weight-loss in both MED groups, they noted that the green-MED group achieved almost double IHF% loss (−38.9% proportionally), as compared with MED (−19.6% proportionally) and HDG (−12.2% proportionally).

• After 18 months, they found that both MED groups had significantly higher total plasma polyphenol levels when compared with the HDG group, with higher detection of Naringenin and 2-5-dihydroxybenzoic-acid among the green-MED group.

• They also noted an independent association noted for greater IHF percentage loss with increased Mankai and walnut intake, decreased red/processed meat consumption, improved serum folate and adipokines/lipids biomarkers, and changes in microbiome composition and specific bacteria.

The authors concluded, "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".

For further information:

https://gut.bmj.com/content/early/2021/01/04/gutjnl-2020-323106