The effectiveness of the
Mediterranean diet (MD) in
non-alcoholic fatty liver disease (
NAFLD) subjects has been evaluated in several randomized controlled trials (RCTs). This systematic review and meta-analysis aimed to evaluate the overall effects of MD intervention in a cohort of
NAFLD patients targeting specific markers such as
central obesity,
lipid profile, liver
enzymes and
fibrosis, and intrahepatic fat (IHF). Google Scholar, PubMed, and Scopus were explored to collect relevant studies from the last 10 years. RCTs with
NAFLD subjects were included in this systematic review with a mean intervention duration from 6 weeks to 1 year, and different intervention strategies, mainly including energy restriction MD (normal or low glycaemic index), low-fat MD with increased monounsaturated and
polyunsaturated fatty acids, and increased exercise expenditure. The outcomes measured in this meta-analysis were gamma-glutamyl
transferase (GGT),
alanine aminotransferase (ALT), total
cholesterol (TC), waist circumference (WC), and
liver fibrosis. Ten randomized controlled trials, which involved a total of 737 adults with
NAFLD, were included. According to the results, the MD seems to decrease the liver stiffness (kPa) by -0.42 (CI95% -0.92, 0.09) (p = 0.10) and significantly reduce the TC by -0.46 mg/dl (CI95% -0.55, -0.38) (p = 0.001), while no significant findings were documented for liver
enzymes and WC among patients with
NAFLD. In conclusion, the MD might reduce indirect and direct outcomes linked with
NAFLD severity, such as TC,
liver fibrosis, and WC, although it is important to consider the variations across trials. Further RCTs are necessary to corroborate the findings obtained and provide further evidence on the role of the MD in the modulation of other disorders related to
NAFLD.