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Diabetologia. 2008 Sep;51(9):1616-22. doi: 10.1007/s00125-008-1049-1. Epub 2008 Jul 3.

A modified Mediterranean diet is associated with the greatest reduction in alanine aminotransferase levels in obese type 2 diabetes patients: results of a quasi-randomised controlled trial.

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Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK.



The aim of the study was to compare the effect of different dietary interventions on alanine aminotransferase (ALT) in obese patients with diabetes.


A post hoc analysis of an open label, parallel design, quasi-randomised (allocation by alternation), controlled trial, conducted in Israel. Obese patients with diabetes (n = 259), treated in the community, were centrally allocated to one of three diets: (1) the 2003 recommended American Diabetes Association diet (ADA): 50-55% carbohydrate, 30% fat and 20% protein, n = 85; (2) a low glycaemic index (LGI) diet: 50-55% LGI carbohydrate, 30% fat, 15-20% protein, n = 89; or (3) a modified Mediterranean diet (MMD): 35% LGI carbohydrate, 45% fat that was high in monounsaturated fat, 15-20% protein, n = 85. ALT was measured at 6 and 12 months.


ALT levels decreased in all arms; however, the MMD was associated with the lowest ALT levels at month 6 (n = 201: ADA n = 64, LGI n = 73, MMD n = 64) and month 12 of follow-up (n = 179). At 12 months mean ALT levels were 19.8 +/- 1.4 U/l in the ADA diet arm (n = 54), 18.0 +/- 1.5 U/l in the LGI diet arm (n = 64) and 14.4 +/- 1.7 in the MMD arm (n = 61, p < 0.001). Evidence for an effect of diet on ALT levels persisted when controlling for post-randomisation changes in waist to hip ratio, BMI, homeostasis model assessment (HOMA) or triacylglycerol.


A Mediterranean diet may have a beneficial effect on liver steatosis in obese patients with diabetes. Results of trials assessing the effect of dietary composition on clinical outcomes should be awaited before a decisive conclusion can be reached. In addition to clinical outcomes, such studies should address the issue of primary prevention of steatosis in high-risk and healthy individuals.

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