Prevention and Reversion of NAFLD in Obese Patients With Metabolic Syndrome by Mediterranean Diet and Physical Activity

Exclusion Criteria

• •Inability or unwillingness to give informed consent or communicate with staff study
• •Documented history of prior cardiovascular disease \[angina; myocardial infarction; coronary revascularization procedures; stroke (ischemic or hemorrhagic including transient ischemic attacks); symptomatic peripheral artery disease that required surgery or was diagnosed with vascular imaging techniques; ventricular arrhythmia; uncontrolled atrial fibrillation; congestive heart failure (New York Heart Association Class III or IV); hypertrophic myocardiopathy; and history of aortic aneurism \>=5.5cm in diameter or aortic aneurism surgery\]
• •Documented history of prior liver diseases (other than NAFLD)
• •Active cancer or a history of malignancy in the last 5 years
• •Low predicted probability to change food habits according to the Stages of Change Model (Nigg, 1999)
• •Unwillingness or inability to adhere to the dietary and physical activity intervention over the entire period of the study
• •Failure to follow scheduled visits
• •Weight loss (\>5 kg) during 6 months prior to visit
• •Previous surgical procedures for weight loss or scheduled bariatric surgery within the next 12 months
• •Use of weight loss medications during 6 months prior to visit
• •Previous history of bowel resection, inflammatory bowel disease
• •Obesity associated with endocrine disease (except treated hypothyroidism)
• •Allergy to Mediterranean diet foods or components
• •Severe psychiatric disorders (schizophrenia, bipolar disorder, eating disorders, or depression with hospitalization within the last 6 months) or Beck Depression Inventory score \> 30
• •Severe condition with less than 24 months life expectancy
• •Chronic abuse of drugs or alcohol (\>21 and \>14 units of alcohol a week for men and women, respectively; 1 unit = 125 mL of wine)
• •Treatment with steroids
• •Pregnancy