A Low Glycemic Index Mediterranean Diet Combined with Aerobic Physical Activity Rearranges the Gut Microbiota Signature in NAFLD Patients.

Nutrients. 2022;14(9)
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Plain language summary

Non-alcoholic fatty liver disease (NAFLD) is the most common metabolic-associated fatty liver disease. The gut microbiota and its metabolites were demonstrated to play a role in the pathophysiology of NAFLD through the gut–liver axis. The aim of this study was to investigate how different lifestyle interventions, including diet and physical activity, can impact the gut microbiota composition in NAFLD patients after 45 and 90 days of treatment. This study was a randomised controlled trial based on lifestyle interventions. Participants were randomly allocated to one of the six groups. Results showed that nutritional therapies based on dietary interventions contributed to reduce the dysbiosis characterising NAFLD patients, increasing the resilience of microbial communities inhabiting the gut. Furthermore, the adoption of an aerobic exercise programme, in combination with the Mediterranean diet, was able to further ameliorate specific ratios of microbes. Authors conclude that the findings of their study highlight the contribution resulting from the synergistic effect of lifestyle interventions (diet and/or physical activity programs) on the composition of the gut microbiota in NAFLD patients.


Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease, and its prevalence worldwide is increasing. Several studies support the pathophysiological role of the gut-liver axis, where specific signal pathways are finely tuned by intestinal microbiota both in the onset and progression of NAFLD. In the present study, we investigate the impact of different lifestyle interventions on the gut microbiota composition in 109 NAFLD patients randomly allocated to six lifestyle intervention groups: Low Glycemic Index Mediterranean Diet (LGIMD), aerobic activity program (ATFIS_1), combined activity program (ATFIS_2), LGIMD plus ATFIS_1 or ATFIS2 and Control Diet based on CREA-AN (INRAN). The relative abundances of microbial taxa at all taxonomic levels were explored in all the intervention groups and used to cluster samples based on a statistical approach, relying both on the discriminant analysis of principal components (DAPCs) and on a linear regression model. Our analyses reveal important differences when physical activity and the Mediterranean diet are merged as treatment and allow us to identify the most statistically significant taxa linked with liver protection. These findings agree with the decreased 'controlled attenuation parameter' (CAP) detected in the LGIMD-ATFIS_1 group, measured using FibroScan®. In conclusion, our study demonstrates the synergistic effect of lifestyle interventions (diet and/or physical activity programs) on the gut microbiota composition in NAFLD patients.

Lifestyle medicine

Fundamental Clinical Imbalances : Digestive, absorptive and microbiological
Patient Centred Factors : Mediators/Gut microbiota
Environmental Inputs : Diet ; Physical exercise ; Microorganisms
Personal Lifestyle Factors : Nutrition ; Exercise and movement
Functional Laboratory Testing : Stool

Methodological quality

Jadad score : 3
Allocation concealment : Yes