Role of Med Diet and wine consumption in the prevention of chronic liver disease

This review examined the association between the Med Diet, its debated wine/alcohol consumption pattern and a reduced risk of liver disease. A specific focus was on the potential preventive role of the Med Diet on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) (*), which is now the most prevalent chronic liver disease globally.

The key findings of this publication are the following:

1. The Med Diet (which usually includes moderate wine/alcohol intake) has been shown to consistently reduce cardiovascular and metabolic risks, effectively lowering liver fat in patients with MASLD. Its high fiber content promotes weight loss and maintenance, especially when combined with exercise.
2. Moderate consumption of red wine with meals is a key feature of the Med Diet, which now seems to be controversial, particularly for patients with MASLD, and has been discouraged in many current clinical guidelines. Several studies have attributed anti-inflammatory properties and a protective effect against cardiovascular disease to red wine. However, much of the evidence on the role of wine/alcohol comes from observational studies with inherent limitations. This fact highlights the need for large randomized controlled trials, such as the UNATI trial (which has just started in Spain), to provide definitive causal evidence.
3. Until such evidence becomes available, the Med Diet remains the most important evidence-based dietary pattern associated with reduced metabolic and hepatic risks.

(*) (MASLD) is a condition where too much fat collects in the liver of individuals who typically have risk factors like obesity, diabetes, high blood pressure, or high cholesterol and who drink little or no alcohol. MASLD used to be called non-alcoholic fatty liver disease (NAFLD).