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Dietary patterns in non-alcoholic fatty liver disease (NAFLD): Stay on the straight and narrow path!
Patrones alimentarios en la enfermedad del hígado graso no alcohólico (EHGNA): ¡siga por el buen camino!
Niki Katsikia,
Corresponding author
nikikatsiki@hotmail.com

Corresponding author.
, Anca Pantea Stoianb, Manfredi Rizzoc,d
a First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece
b Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
c Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy
d Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of South Carolina, Columbia, SC, USA
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The role of diet in NAFLD treatment&#46; NAFLD&#58; non-alcoholic fatty liver disease&#59; DASH&#58; Dietary Approaches to Stop Hypertension&#59; BMI&#58; body mass index&#59; BP&#58; blood pressure&#59; WC&#58; waist circumference&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Non-alcoholic fatty liver disease &#40;NAFLD&#41; is the major cause of hepatic disease worldwide&#44; affecting over 25&#37; of the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">1</span></a> The prevalence of NAFLD is further increased in obese individuals and patients with type 2 diabetes &#40;T2D&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">2</span></a> Histologically&#44; NAFLD begins as simple steatosis &#40;i&#46;e&#46;&#44; &#62;5&#37; liver fat accumulation without inflammation&#41; and can progress to the more severe form of non-alcoholic steatohepatitis &#40;NASH&#41; &#40;with inflammation&#44; necrosis&#44; ballooning and fibrosis&#41;&#44; potentially leading to liver cirrhosis&#44; hepatocellular carcinoma and end-stage liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">3</span></a> Apart from liver morbidity and mortality&#44; NAFLD&#47;NASH patients have also an increased cardiovascular &#40;CV&#41; risk&#44; with more patients dying from a CV event than a liver-related cause&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Taken into consideration that the epidemic of obesity and T2D is constantly increasing globally&#44; NAFLD prevalence is also increasing proportionately&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">2</span></a> Therefore&#44; there is an urgent need to tackle this tremendous clinical and economic burden by preventing and&#47;or treating NAFLD&#47;NASH&#46; Although there are some drugs &#40;e&#46;g&#46;&#44; hypolipidemic and antidiabetic&#41; that have been reported to improve the biochemical and histological features of NAFLD&#47;NASH&#44;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">4&#8211;7</span></a> there is currently no drug therapy officially approved for this disease and thus&#44; lifestyle interventions remain the first-line therapeutic option&#46; Nutrition research is now focusing on healthy dietary patterns &#40;and not on single nutrients or specific foods&#41; to identify the optimal diets for chronic disease prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">8</span></a> In the present narrative review&#44; we discuss the effects of certain dietary patterns on NAFLD&#47;NASH incidence and progression&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Mediterranean diet &#40;MedDiet&#41; and NAFLD</span><p id="par0015" class="elsevierStylePara elsevierViewall">MedDiet is the most widely studied dietary pattern in scientific literature&#44; found to exert&#44; apart from weight loss&#44; several other health benefits such as improvements in oxidative stress and inflammatory markers&#44; insulin sensitivity&#44; glucose and lipid metabolism&#44; endothelial and antithrombotic function&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">9&#8211;11</span></a> These beneficial effects of the MedDiet have been largely attributed to certain dietary components&#44; including monounsaturated fatty acids &#40;mainly olive oil&#41;&#44; polyunsaturated fatty acids &#40;from nuts&#44; seed and fish&#41;&#44; as well as plant-based foods &#40;such as vegetables&#44; legumes and fruits&#41;&#46; A higher adherence to the MedDiet has been related to lower risks of all-cause mortality&#44; CV morbidity and death&#44; metabolic diseases and cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">9</span></a> MedDiet is considered for the prevention of cardiometabolic and degenerative diseases&#44; focusing on its beneficial impact as a holistic dietary approach&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">12</span></a> In this context&#44; it has been shown that adherence to the MedDiet can lower the risk of developing NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several cross-sectional and randomized clinical trials have been conducted to test the effects of MedDiet in NAFLD&#47;NASH patients&#44; as reviewed elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">14&#44;15</span></a> In these trials&#44; MedDiet was reported to reduce weight&#44; BMI&#44; BP&#44; oxidative stress&#44; inflammation&#44; insulin resistance&#44; fasting glucose and lipids&#44; as well as NAFLD score&#44; intrahepatic fat content&#44; liver tests&#44; hepatic steatosis&#44; stiffness and fibrosis and NAFLD severity and progression&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">16&#44;17</span></a> Of note&#44; the hepatometabolic benefits induced by the MedDiet are independent of weight loss&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">18</span></a> In meta-analyses involving NAFLD patients&#44; implementation of the MedDiet was shown to improve weight&#44; insulin resistance&#44; dyslipidemia&#44; liver tests&#44; steatosis and NAFLD severity indices&#44; as well as to decrease overall mortality and morbidity&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">15&#44;19&#8211;22</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the above&#44; MedDiet is recommended in individuals with NAFLD&#47;NASH&#44; since it can improve both liver steatosis and several CV risk factors&#44; thus also protecting from CV morbidity&#47;mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">23</span></a> Indeed&#44; current guidelines&#44; including the National Institute for Health and Care Excellence &#40;NICE&#41;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">24</span></a> and the joint recommendation from the European Association for the Study of the Liver &#40;EASL&#41;&#44; the European Association for the Study of Diabetes &#40;EASD&#41; and the European Association for the Study of Obesity &#40;EASO&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">25</span></a> strongly support the implementation of MedDiet in NAFLD&#47;NASH patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Overall&#44; the MedDiet is superior to other diets in preventing&#47;treating NAFLD&#47;NASH&#44; as well as MetS and its components&#44; T2D and CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">18</span></a> Furthermore&#44; MedDiet is easier to follow and has greater scientific evidence for cardiometabolic benefits compared with other dietary patterns&#46; Therefore&#44; it is recommended as the diet of choice for the prevention&#47;treatment of NAFLD&#47;NASH and its complications&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Dietary Approach to Stop Hypertension &#40;DASH&#41; diet and NAFLD</span><p id="par0035" class="elsevierStylePara elsevierViewall">DASH diet has been shown to significantly reduce body weight&#44; BP&#44; LDL-C&#44; total cholesterol and HbA1c&#44; as well as protect against CVD and T2D incidence&#44; thus representing an attractive option for overweight&#47;obese patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">26&#44;27</span></a> There is also some evidence on DASH diet-induced benefits in NAFLD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">28</span></a> In this context&#44; in a cross-sectional analysis of the Guangzhou Nutrition and Health Study &#40;a population-based cohort study&#44; involving 3051 participants&#41;&#44; adherence to the DASH diet &#40;defined by higher DASH diet score&#41; was independently associated with a significantly lower prevalence of NAFLD&#44; as well as with reduced levels of inflammation&#44; insulin resistance and BMI&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">29</span></a> A similar inverse relationship between the DASH diet and the risk of NAFLD was reported in a case&#8211;control study with 102 NAFLD patients &#40;diagnosed by transient elastography&#41; and 204 controls&#44;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">30</span></a> as well as in a nested case&#8211;control analysis of the Multiethnic Cohort &#40;MEC&#41; &#91;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2959 NAFLD cases &#40;509 with cirrhosis&#41; and 29&#44;292 controls&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">31</span></a> In the latter study&#44; the inverse association was even greater for NAFLD patients with than those without cirrhosis&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">31</span></a> Apart from NAFLD risk&#44; DASH score has also been inversely associated with liver fat content &#40;measured by MRI&#41; in a cross-sectional study of 136 non-diabetic non-smokers individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">32</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In a randomized controlled trial &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60 overweight&#47;obese NAFLD patients&#44; diagnosed by ultrasonography and increased ALT levels&#41;&#44; implementation of the DASH diet for 8 weeks was reported to significantly improve weight&#44; BMI&#44; ALT&#44; insulin resistance and TG&#44; as well as markers of inflammation and oxidative stress compared with the control diet&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">33</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Overall&#44; the DASH diet can beneficially affect several cardiometabolic risk factors&#44; as well as protect against CVD and T2D development&#46; Further data is needed to clarify its efficacy in NAFLD&#47;NASH biochemical and histological features&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ketogenic diet and NAFLD</span><p id="par0050" class="elsevierStylePara elsevierViewall">Low-carbohydrate ketogenic diets &#40;KD&#41; have been reported to significantly reduce intrahepatic TG content within 48<span class="elsevierStyleHsp" style=""></span>h in obese individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">34</span></a> Apart from weight loss&#44; KD may decrease insulin levels and lipogenesis&#44; as well as increase fatty acid oxidation &#40;due to their very low carbohydrate content&#41;&#44; and even beneficially affect liver pathology &#40;due to the role of ketone bodies as moderators of fibrosis and inflammation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">35</span></a> Reduced hepatic insulin resistance and increased hepatic mitochondrial redox state&#44; promoting the net hydrolysis of intrahepatic TG and thus ketogenesis from the resulting fatty acids&#44; have also been implicated in KD-related NAFLD reversal&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">36</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In a pilot&#44; open-label&#44; randomized controlled trial involving 18 obese women with polycystic ovary syndrome&#44; KD for 12 weeks was superior in lowering ALT and AST&#44; and improving liver ultrasound features compared with the control group &#40;receiving Essentiale plus Yasmin&#44; i&#46;e&#46;&#44; conventional drug treatment&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">37</span></a> Furthermore&#44; a very low-calorie KD led to greater reductions in body weight&#44; visceral adipose tissue and liver fat content compared with a standard low-calorie diet in 39 obese patients after 2 months of intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">38</span></a> The authors suggested that this rapid mobilization of hepatic fat and weight loss induced by KD could serve as an effective alternative for NAFLD treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">38</span></a> It has also been reported that obese men may experience larger benefits &#40;in terms of body weight and liver tests reduction&#41; with very low-carbohydrate KD compared with pre-menopausal women&#59; these differences are lessened after menopause&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">39</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The implementation of a hypocaloric KD for 6&#46;5 months was shown to significantly improve body weight&#44; systolic BP&#44; TG&#44; ALT&#44; AST and fibrosis score in 38 patients with NASH &#40;diagnosed by liver biopsy&#44; transient elastography&#44; magnetic resonance elastography or liver test abnormalities&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">40</span></a> However&#44; long-term maintenance on a KD could lead to increases in liver tests and induce lipid and glucose disorders &#40;due to their high-fat content&#41; and thus increased vigilance and monitoring is encouraged in patients on such a diet&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">41&#44;42</span></a> Overall&#44; further clinical evidence is needed to establish the role &#40;and ideal duration&#41; of KD in NAFLD prevention and treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Intermittent fasting diet and NAFLD</span><p id="par0065" class="elsevierStylePara elsevierViewall">In an open-label randomized controlled trial&#44; 74 patients with NAFLD &#40;diagnosed by ultrasound&#44; CT&#44; MRI or transient elastography&#41; were assigned in a 1&#58;1&#58;1 ratio to intermittent calorie restriction diet &#40;the 5&#58;2 diet&#41;&#44; low-carb high-fat diet &#40;LCHF&#41; or general lifestyle advice &#40;standard of care&#59; SoC&#41; and followed-up for 12 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">43</span></a> Of note&#44; participants in the 5&#58;2 group were instructed to consume 600<span class="elsevierStyleHsp" style=""></span>kcal&#47;day for men and 6500<span class="elsevierStyleHsp" style=""></span>kcal&#47;day for women on 2 non-consecutive days per week&#46; Both 5&#58;2 and LCHF diets were superior to SoC treatment in terms of body weight and liver steatosis reduction &#40;measured by MRS&#41;&#44; leading to similar improvements&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">43</span></a> Furthermore&#44; the 5&#58;2 diet &#40;but not the LCHF diet&#41; also reduced liver stiffness and LDL-C and was better tolerated than LCHF&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">43</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Periodic fasting was also shown to significantly reduce FLI in 697 individuals with or without T2D in a prospective observational trial&#59; the magnitude of this benefit was greater in T2D patients&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">44</span></a> Body weight&#44; BMI&#44; waist circumference&#44; fasting glucose&#44; HbA1c and liver enzymes were also significantly decreased after periodic fasting&#46; FLI improvement correlated with the number of fasting days and the extent of BMI reduction&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">44</span></a> After fasting&#44; almost half of the participants with baseline FLI &#8805;60 &#40;representing the threshold for NAFLD&#41; shifted to a lower category of FLI risk&#44; thus suggesting liver disease reversion&#46; It should be noted that periodic fasting was implemented as it follows&#58; an initial phase of a low-calorie transition day &#40;600<span class="elsevierStyleHsp" style=""></span>kcal&#47;day mono-diet consisting of vegetables&#44; fruits&#44; oat or rice&#41;&#44; followed by the fasting period &#40;250<span class="elsevierStyleHsp" style=""></span>mL vegetable broth or fruit juice at midday&#44; 250<span class="elsevierStyleHsp" style=""></span>mL vegetable broth in the evening and 20<span class="elsevierStyleHsp" style=""></span>g honey optionally&#41;&#44; and then a stepwise reintroduction of food &#40;lacto-ovo-vegetarian food increasing from 800 to 1800<span class="elsevierStyleHsp" style=""></span>kcal&#47;day over at least 3 days&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">44</span></a> The participants were advised to drink &#8805;2<span class="elsevierStyleHsp" style=""></span>L of water&#47;day&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Alternate-day fasting was reported to significantly decrease insulin resistance&#44; total cholesterol&#44; LDL-C&#44; liver weight and ALT in animal models of MetS&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">45</span></a> Similarly&#44; significant reductions in body weight&#44; fat mass&#44; total cholesterol and TG were observed among 271 patients with NAFLD &#40;assessed by ultrasound&#41; following alternate-day fasting or time-restricted feeding for 12 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">46</span></a> In another randomized clinical trial&#44; involving 43 patients with NAFLD &#40;defined by elevated liver tests&#41;&#44; alternate-day calorie restriction for 8 weeks significantly lowered BMI&#44; ALT&#44; liver steatosis grades and fibrosis scores compared with habitual diet&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">47</span></a> Alternate-day diet was well-tolerated with good adherence rate throughout the study&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">47</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">There is some evidence that Ramadan fasting can improve NAFLD features&#46; In this context&#44; among 83 NAFLD patients&#44; body weight&#44; BMI&#44; waist circumference&#44; waist-to-hip ratio and body fat percentage were significantly reduced in those who performed Ramadan fasting compared with the non-fasting group&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">48</span></a> Significant improvements in liver tests&#44; steatosis&#44; inflammatory markers&#44; insulin sensitivity and NAFLD severity scores have also been reported following Ramadan fasting in NAFLD&#47;NASH patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">49&#44;50</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A recent meta-analysis&#44; including 6 studies &#40;4 used Ramadan fasting and 2 used alternate-day fasting&#41; with a total of 417 NAFLD patients&#44; further supports the beneficial effects of intermittent fasting on body weight&#44; BMI and liver tests&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">51</span></a> The authors concluded that long-term safety and feasibility of intermittent fasting should be evaluated in the future&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">51</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Overall&#44; further studies&#44; including a control group and long-term follow-up&#44; are needed to establish the positive effects of different types of intermittent fasting &#40;e&#46;g&#46;&#44; 5&#58;2&#44; alternate-day&#44; periodic and Ramadan fasting&#44; as well as 16&#47;8 involving 16<span class="elsevierStyleHsp" style=""></span>h fasting every day&#41; on NAFLD development and progression&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Vegetarian &#40;vegan&#41; diet and NAFLD</span><p id="par0095" class="elsevierStylePara elsevierViewall">A cross-sectional study&#44; involving 2127 nonvegetarians and 1273 vegetarians &#40;all healthy volunteers&#41;&#44; showed that the odds for fatty liver &#40;measured by ultrasound&#41; were significantly lower &#40;by 21&#37;&#41; in vegetarians compared with nonvegetarians&#44; even after adjustment for gender&#44; age&#44; smoking&#44; alcohol intake and education&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">52</span></a> However&#44; BMI slightly attenuated this association&#46; Furthermore&#44; nonvegetarians had a more severe fibrosis score than vegetarians&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">52</span></a> The authors suggested that the observed liver benefits from the vegetarian diet may be attributed to its rich content in polyphenols which can decrease inflammation&#44; oxidative stress and insulin resistance&#44; thereby suppressing NAFLD progression&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">52</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">A previous analysis of data from the Mediators of Atherosclerosis in South Asians Living in America &#40;MASALA&#41; study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>892 participants&#41; reported that the consumption of a vegetarian diet was associated with lower BMI&#44; fasting glucose&#44; insulin resistance&#44; total cholesterol and LDL-C&#44; as well as a lower &#40;by 57&#37;&#41; risk of fatty liver &#91;assessed by CT&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">53</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In a 3-month randomized clinical trial with 75 overweight&#47;obese NAFLD patients&#44; lacto-ovo-vegetarian diet &#40;based on eliminating poultry&#44; meat and fish&#44; but including eggs and dairy products&#41; was compared with a standard weight-loss diet &#40;based on the standard food pyramid&#44; free in all sources of food&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">54</span></a> Patients following the lacto-ovo-vegetarian diet showed greater improvements in body weight&#44; BMI&#44; waist circumference&#44; ALT&#44; fasting glucose&#44; insulin resistance&#44; TG&#44; LDL-C and systolic BP&#44; as well as a greater alleviation of NAFLD grade &#40;in ultrasonography&#41; compared with those on the weight-loss diet&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">54</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In another prospective&#44; pilot study&#44; 26 NAFLD patients followed a strict vegan diet &#40;excluding all animal products&#41; for 6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">55</span></a> At the end of the study&#44; liver enzymes &#40;ALT&#44; AST&#44; GGT&#41; were significantly improved and even normalized in 20&#47;26 patients&#46; Of note&#44; body weight and BMI were also significantly decreased but this reduction did not correlate with the normalization of liver tests&#44; thus highlighting the fact that a vegan diet can beneficially affect liver function&#44; irrespective of weight loss&#46;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">55</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">A previous cross-sectional&#44; retrospective study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>615&#41; compared NAFLD prevalence &#40;measured by ultrasound&#41; between Buddhist priests &#40;being vegetarians&#41; and controls &#40;matched for age&#44; gender&#44; BMI and presence&#47;absence of MetS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">56</span></a> No difference was observed in NAFLD prevalence between the 2 groups&#44; with Buddhist priests also having higher liver tests &#40;ALT&#44; AST&#41; and TG levels&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">56</span></a> The authors concluded that &#8220;The vegetarian diet does not protect against NAFLD&#8221;&#44; however such a statement seems too strong for such limited data and cannot be supported by these results&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Overall&#44; healthy plant-based diets &#40;as the vegetarian&#41; were related to a lower NAFLD risk &#40;defined by FLI&#41; and more favorable liver tests as shown in cross-sectional study using data from the US National Health and Nutrition Examination Survey &#40;NHANES&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">57</span></a> Such dietary patterns &#40;including Mediterranean&#44; DASH and vegetarian diets&#41; have been proposed for NAFLD&#47;NASH management&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">58</span></a> Further research should focus on the effects of the vegetarian diet and its subtypes &#40;e&#46;g&#46;&#44; lacto-&#44; ovo-&#44; lacto<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ovo-&#44; pescatarian&#44; vegan&#41; on liver biochemistry and histology in NAFLD&#47;NASH patients&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Paleo diet and NAFLD</span><p id="par0125" class="elsevierStylePara elsevierViewall">Data on the effects of the paleo&#40;lithic&#41;-type diet &#40;also known as the Hunter-Gatherer diet&#41; in NAFLD&#47;NASH patients is lacking&#46; A single-blinded&#44; randomized controlled&#44; pilot study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32 individuals with &#8805;2 MetS features&#41; found that a 2-week paleo diet significantly lowered body weight&#44; BP&#44; total cholesterol and TG&#44; as well as increased HDL-C&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">59</span></a> These effects could also be beneficial in NAFLD&#47;NASH patients&#46; Indeed&#44; the paleolithic diet &#40;based on vegetables&#44; fruits&#44; vegetables&#44; nuts&#44; roots and organ meats&#41; has been reported to improve dyslipidemia&#44; hypertension&#44; body weight&#44; waist circumference&#44; fasting glucose and insulin resistance&#46;<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">60&#44;61</span></a> In another randomized study&#44; involving 70 healthy&#44; obese&#44; postmenopausal women&#44; liver fat &#40;assessed by proton MRS&#41; was significantly lower in women following a paleo diet for 6 months compared with those on a low-fat diet&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">62</span></a> However&#44; this difference in liver fat reduction lost its statistical significance at 24 months&#46; Furthermore&#44; the consumption of a paleo diet for 5 weeks led to a significant decrease in liver TG content &#40;measured by proton MRS&#41;&#44; as well as improvements in BMI&#44; fasting glucose&#44; BP&#44; lipids&#44; waist and hip circumference&#44; waist&#47;hip ratio and abdominal sagittal diameter in 10 healthy postmenopausal women&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">63</span></a> Similarly&#44; body weight and fat mass&#44; as well as liver fat &#40;assessed by MRS&#41; were significantly reduced in 32 overweight-obese T2D patients that followed a paleolithic diet &#40;with or without exercise&#41; for 12 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">64</span></a> Adipose and peripheral tissue &#40;but not hepatic&#41; insulin sensitivity was also improved&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Overall&#44; the paleo diet seems a promising asset in preventing&#47;treating NAFLD but well-designed&#44; long-term&#44; clinical trials are needed to elucidate the impact of this dietary pattern on biochemical and&#47;or histological NAFLD&#47;NASH parameters&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the abovementioned beneficial effects of different dietary patterns on cardiometabolic and liver parameters observed in NAFLD patients&#46; These diet-induced benefits could prevent&#47;minimize CVD and liver morbidity&#47;mortality &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">It should be noted that recently&#44; have proposed a new definition of fatty liver has been proposed by several international expert panels&#44; namely metabolic dysfunction-associated fatty liver disease &#40;MAFLD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">65</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">Currently&#44; diet-induced weight loss is regarded as the first therapeutic approach in NAFLD&#47;NASH to resolve steatosis and reverse fibrosis&#46; Plant-based dietary patterns&#44; poor in saturated fat&#44; refined carbohydrates&#44; red and processed meats&#44; are preferred&#44; including the Mediterranean&#44; DASH and vegetarian&#47;vegan diets&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">58</span></a> Such dietary patterns have previously been recommended for the prevention and treatment of MetS&#46;<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">66</span></a> Since NAFLD is considered as the hepatic manifestation of MetS&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">5</span></a> it follows that these diets can also be beneficial for NAFLD&#47;NASH patients&#46; MedDiet is regarded as the diet of choice for the prevention&#47;treatment of NAFLD&#47;NASH and its complications&#44; based on the available evidence&#46; Future well-designed clinical trials will establish the role of each of these dietary patterns&#44; as well as of KD&#44; intermittent fasting and paleo diets in NAFLD&#47;NASH prevention and treatment&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nevertheless&#44; since psychological&#44; social&#44; cultural and economic factors&#44; as well as co-morbidities may differ&#44; there is no &#8220;one-size-fits-all&#8221; dietary intervention for NAFLD management&#46; Clinicians should discuss the different dietary patterns with their patients and define the diet that each individual prefers and is able to implement in his&#47;her daily life&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that the current research was conducted independently&#44; in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NK</span> has given talks&#44; attended conferences and participated in trials sponsored by Angelini&#44; Astra Zeneca&#44; Bausch Health&#44; Boehringer Ingelheim&#44; Elpen&#44; Mylan&#44; Novo Nordisk&#44; Sanofi and Servier&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">APS</span> is currently Vice President of Romanian National Diabetes Committee&#44; and she has given lectures&#44; received honoraria and research support&#44; and participated in conferences&#44; advisory boards&#44; and clinical trials sponsored by many pharmaceutical companies&#44; including AstraZeneca&#44; Boehringer Ingelheim&#44; Medtronic&#44; Eli Lilly&#44; Merck&#44; Novo Nordisk&#44; Novartis&#44; Roche Diagnostics&#44; and Sanofi&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MR</span> is a full-time Professor of Internal Medicine at University of Palermo&#44; Italy&#44; and currently Section Editor in Chief for the International Journal of Molecular Sciences and Medical Director&#44; Novo Nordisk in Eastern Europe&#59; he has given lectures&#44; received honoraria and research support&#44; and participated in conferences&#44; advisory boards&#44; and clinical trials sponsored by many pharmaceutical companies including Amgen&#44; Astra Zeneca&#44; Boehringer Ingelheim&#44; Kowa&#44; Eli Lilly&#44; Meda&#44; Mylan&#44; Merck Sharp &#38; Dohme&#44; Novo Nordisk&#44; Novartis&#44; Roche Diagnostics&#44; Sanofi and Servier&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">None of the above had any role in this article&#44; which has been written independently&#44; without any financial or professional help&#44; and reflects only the authors&#8217; opinion&#44; without any role of the industry&#46;</p></span></span>"
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          "titulo" => "Mediterranean diet &#40;MedDiet&#41; and NAFLD"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Non-alcoholic fatty liver disease &#40;NAFLD&#41; is the most frequent hepatic disease globally&#46; NAFLD patients are at an increased risk of both liver and cardiovascular morbidity and mortality&#44; as well as all-cause death&#46; NAFLD prevalence is rapidly increasing worldwide and&#44; thus&#44; there is an urgent need for health policies to tackle its development and complications&#46; Currently&#44; since there is no drug therapy officially indicated for this disease&#44; lifestyle interventions remain the first-line therapeutic option&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In the present narrative review&#44; we discuss the effects of certain dietary patterns on NAFLD incidence and progression&#46; The Mediterranean diet is regarded as the diet of choice for the prevention&#47;treatment of NAFLD and its complications&#44; based on the available evidence&#46; Other plant-based dietary patterns &#40;poor in saturated fat&#44; refined carbohydrates&#44; red and processed meats&#41; are also beneficial &#91;i&#46;e&#46;&#44; Dietary Approaches to Stop Hypertension &#40;DASH&#41; and vegetarian&#47;vegan diets&#93;&#44; whereas more data are needed to establish the role of ketogenic&#44; intermittent fasting and paleo diets in NAFLD&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nevertheless&#44; there is no &#8220;one-size-fits-all&#8221; dietary intervention for NAFLD management&#46; Clinicians should discuss with their patients and define the diet that each individual prefers and is able to implement in his&#47;her daily life&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de h&#237;gado graso no alcoh&#243;lico &#40;EHGNA&#41; es la enfermedad hep&#225;tica m&#225;s frecuente a nivel global&#46; Los pacientes de EHGNA tienen un riesgo incrementado de morbilidad y mortalidad hep&#225;tica y cardiovascular&#44; y muerte por cualquier causa&#46; La prevalencia de EHGNA se est&#225; incrementando r&#225;pidamente a nivel mundial&#44; y por tanto existe una necesidad urgente de pol&#237;ticas sanitarias para afrontar su desarrollo y complicaciones&#46; Actualmente&#44; dado que no existe ninguna terapia farmacol&#243;gica indicada de manera oficial para esta enfermedad&#44; las intervenciones sobre el estilo de vida siguen siendo la opci&#243;n terap&#233;utica de primera l&#237;nea&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En la revisi&#243;n de la narrativa actual debatimos los efectos de ciertos patrones alimentarios en la incidencia y progresi&#243;n de EHGNA&#46; La dieta mediterr&#225;nea se considera la dieta de elecci&#243;n para la prevenci&#243;n&#47;tratamiento de EHGNA y sus complicaciones&#44; sobre la base de la evidencia disponible&#46; Otros patrones alimentarios basados en plantas &#40;bajos en grasas saturadas&#44; hidratos de carbono refinados&#44; carnes rojas y procesadas&#41; son tambi&#233;n beneficiosos &#8212;es decir&#44; DASH &#40;<span class="elsevierStyleItalic">Dietary Approaches to Stop Hypertension</span> &#91;Enfoques alimentarios para detener la hipertensi&#243;n&#93;&#41; y dietas vegetarianas&#47;veganas&#8212;&#44; aunque se necesitan m&#225;s datos para establecer el papel de las dietas cetog&#233;nicas&#44; de ayuno intermitente y paleo en la EHGNA&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sin embargo&#44; no existe una intervenci&#243;n alimentaria &#171;universal&#187; para el manejo de EHGNA&#46; Los cl&#237;nicos deber&#225;n debatir con sus pacientes y definir la dieta que prefiera cada individuo&#44; y que este pueda introducir en su vida diaria&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The role of diet in NAFLD treatment&#46; NAFLD&#58; non-alcoholic fatty liver disease&#59; DASH&#58; Dietary Approaches to Stop Hypertension&#59; BMI&#58; body mass index&#59; BP&#58; blood pressure&#59; WC&#58; waist circumference&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; BP&#58; blood pressure&#59; TG&#58; triglycerides&#59; LDL-C&#58; low-density lipoprotein cholesterol&#59; ALT&#58; alanine transaminase&#59; AST&#58; aspartate transaminase&#59; NAFLD&#58; non-alcoholic fatty liver disease&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dietary pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Beneficial effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Mediterranean diet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Body weightBMIBPOxidative stressInflammationInsulin resistanceFasting glucoseFasting lipidsNAFLD scoreIntrahepatic fat contentLiver testsHepatic steatosisLiver stiffnessHepatic fibrosisNAFLD severity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dietary Approaches to Stop Hypertension &#40;DASH&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Body weightBMIInflammationInsulin resistanceFasting lipidsFasting TGALTLiver fat content&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Vegetarian diet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Body weightBMIWaist circumferenceSystolic BPFasting glucoseInsulin resistanceTG&#44; LDL-CALTLiver fatNAFLD grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ketogenic diet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Body weightSystolic BPFasting TGLiver tests &#40;ALT&#44; AST&#41;Liver fibrosis scoreHepatic insulin resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermittent fasting diet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Body weightBMIBody fat massInflammationInsulin sensitivityFasting total cholesterol and TGLiver tests &#40;ALT&#44; AST&#41;Liver steatosisHepatic stiffnessLiver fibrosisNAFLD severity scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Paleo diet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Data in NAFLD patients are missingBMIBody fat massWaist and hip circumferenceWaist&#47;hip ratioBPInsulin resistanceFasting glucoseFasting lipidsLiver fat&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Beneficial effects of different dietary patterns on cardiometabolic and liver parameters observed in NAFLD patients&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:66 [
            0 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence&#44; incidence&#44; and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Z&#46;M&#46; Younossi"
                            1 => "A&#46;B&#46; Koenig"
                            2 => "D&#46; Abdelatif"
                            3 => "Y&#46; Fazel"
                            4 => "L&#46; Henry"
                            5 => "M&#46; Wymer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.28431"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2016"
                        "volumen" => "64"
                        "paginaInicial" => "73"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26707365"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Younossi"
                            1 => "F&#46; Tacke"
                            2 => "M&#46; Arrese"
                            3 => "B&#46; Chander Sharma"
                            4 => "I&#46; Mostafa"
                            5 => "E&#46; Bugianesi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.30251"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2019"
                        "volumen" => "69"
                        "paginaInicial" => "2672"
                        "paginaFinal" => "2682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30179269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular risk across the histological spectrum and the clinical manifestations of non-alcoholic fatty liver disease&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46;G&#46; Athyros"
                            1 => "K&#46; Tziomalos"
                            2 => "N&#46; Katsiki"
                            3 => "M&#46; Doumas"
                            4 => "A&#46; Karagiannis"
                            5 => "D&#46;P&#46; Mikhailidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.v21.i22.6820"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "6820"
                        "paginaFinal" => "6834"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26078558"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-alcoholic fatty liver disease treatment in patients with type 2 diabetes mellitus&#59; new kids on the block"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;G&#46; Athyros"
                            1 => "S&#46;A&#46; Polyzos"
                            2 => "J&#46; Kountouras"
                            3 => "N&#46; Katsiki"
                            4 => "P&#46; Anagnostis"
                            5 => "M&#46; Doumas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2174/1570161117666190405164313"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Vasc Pharmacol"
                        "fecha" => "2020"
                        "volumen" => "18"
                        "paginaInicial" => "172"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30961499"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is nonalcoholic fatty liver disease indeed the hepatic manifestation of metabolic syndrome&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Katsiki"
                            1 => "P&#46; Perez-Martinez"
                            2 => "P&#46; Anagnostis"
                            3 => "D&#46;P&#46; Mikhailidis"
                            4 => "A&#46; Karagiannis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2174/1570161115666170621075619"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Vasc Pharmacol"
                        "fecha" => "2018"
                        "volumen" => "16"
                        "paginaInicial" => "219"
                        "paginaFinal" => "227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28669328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus&#58; effects of statins and antidiabetic drugs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Katsiki"
                            1 => "V&#46;G&#46; Athyros"
                            2 => "D&#46;P&#46; Mikhailidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jdiacomp.2016.12.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Diabetes Complications"
                        "fecha" => "2017"
                        "volumen" => "31"
                        "paginaInicial" => "521"
                        "paginaFinal" => "522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28089090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of statins alone&#44; or in combination with pioglitazone and other drugs&#44; for the treatment of non-alcoholic fatty liver disease&#47;non-alcoholic steatohepatitis and related cardiovascular risk&#46; An expert panel statement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;G&#46; Athyros"
                            1 => "T&#46;K&#46; Alexandrides"
                            2 => "H&#46; Bilianou"
                            3 => "E&#46; Cholongitas"
                            4 => "M&#46; Doumas"
                            5 => "E&#46;S&#46; Ganotakis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.metabol.2017.02.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Metabolism"
                        "fecha" => "2017"
                        "volumen" => "71"
                        "paginaInicial" => "17"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28521870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary habits&#44; lipoprotein metabolism and cardiovascular disease&#58; from individual foods to dietary patterns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Gomez-Delgado"
                            1 => "N&#46; Katsiki"
                            2 => "J&#46; Lopez-Miranda"
                            3 => "P&#46; Perez-Martinez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/10408398.2020.1764487"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Rev Food Sci Nutr"
                        "fecha" => "2021"
                        "volumen" => "61"
                        "paginaInicial" => "1651"
                        "paginaFinal" => "1669"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32515660"
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                      "titulo" => "Mediterranean diet and health status&#58; active ingredients and pharmacological mechanisms"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Schwingshackl"
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                    0 => array:2 [
                      "doi" => "10.1111/bph.14778"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Pharmacol"
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                        "volumen" => "177"
                        "paginaInicial" => "1241"
                        "paginaFinal" => "1257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31243760"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The fluid aspect of the Mediterranean diet in the prevention and management of cardiovascular disease and diabetes&#58; the role of polyphenol content in moderate consumption of wine and olive oil"
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                          "autores" => array:6 [
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                            3 => "A&#46;I&#46; P&#233;rez-Caballero"
                            4 => "P&#46; Demelo-Rodr&#237;guez"
                            5 => "J&#46; Lopez-Miranda"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "paginaInicial" => "2833"
                      ]
                    ]
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              "identificador" => "bib0385"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Olive oil intake and cardiovascular disease prevention&#58; &#8220;seek and you shall find&#8221;"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
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                            2 => "J&#46; Lopez-Miranda"
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                      ]
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                  "host" => array:1 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Cardiol Rep"
                        "fecha" => "2021"
                        "volumen" => "23"
                        "paginaInicial" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33961163"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Health benefits of the Mediterranean Diet&#58; an update of research over the last 5 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Gotsis"
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                            3 => "A&#46; Vlachou"
                            4 => "N&#46; Katsiki"
                            5 => "A&#46; Karagiannis"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Angiology"
                        "fecha" => "2015"
                        "volumen" => "66"
                        "paginaInicial" => "304"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24778424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0395"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Overview of Non-Alcoholic Fatty Liver Disease &#40;NAFLD&#41; and the role of sugary food consumption and other dietary components in its development"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Vancells Lujan"
                            1 => "E&#46; Vi&#241;as Esmel"
                            2 => "E&#46; Sacanella Meseguer"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.3390/nu13051442"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients"
                        "fecha" => "2021"
                        "volumen" => "13"
                        "paginaInicial" => "1442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33923255"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediterranean diet and nonalcoholic fatty liver disease"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Anania"
                            1 => "F&#46;M&#46; Perla"
                            2 => "F&#46; Olivero"
                            3 => "L&#46; Pacifico"
                            4 => "C&#46; Chiesa"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.v24.i19.2083"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2018"
                        "volumen" => "24"
                        "paginaInicial" => "2083"
                        "paginaFinal" => "2094"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29785077"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The significance of the Mediterranean diet in the management of non-alcoholic fatty liver disease&#58; a systematic review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Gosal"
                            1 => "H&#46; Kaur"
                            2 => "H&#46; Chakwop Ngassa"
                            3 => "K&#46;A&#46; Elmenawi"
                            4 => "V&#46; Anil"
                            5 => "L&#46; Mohammed"
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.7759/cureus.15618"
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                        "tituloSerie" => "Cureus"
                        "fecha" => "2021"
                        "volumen" => "13"
                        "paginaInicial" => "e15618"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34277236"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0410"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Effect of the Mediterranean diet on histological indicators and imaging tests in non-alcoholic fatty liver disease"
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                          "etal" => false
                          "autores" => array:3 [
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                            2 => "K&#46; Priken"
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                  "host" => array:1 [
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                        "tituloSerie" => "Gastroenterol Hepatol"
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              "identificador" => "bib0415"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Mediterranean diet and NAFLD&#58; what we know and questions that still need to be answered"
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                          "etal" => true
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                            2 => "A&#46; Lleo"
                            3 => "G&#46; Bodini"
                            4 => "M&#46; Furnari"
                            5 => "E&#46; Marabotto"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Nutrients"
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            17 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The Mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease&#58; evidence and plausible mechanisms"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Liver Int"
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                        "paginaInicial" => "936"
                        "paginaFinal" => "949"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28371239"
                            "web" => "Medline"
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              "identificador" => "bib0425"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Effects of the Mediterranean diet on cardiovascular risk factors in non-alcoholic fatty liver disease patients&#58; a systematic review and meta-analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            2 => "D&#46; Ashtary-Larky"
                            3 => "A&#46; Abbasnezhad"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32359737"
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                ]
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              "identificador" => "bib0430"
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                        "link" => array:1 [
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                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
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                    0 => array:2 [
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                            4 => "E&#46;G&#46; Giannini"
                            5 => "A&#46; Aghemo"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0450"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Guideline Development Group Non-alcoholic fatty liver disease &#40;NAFLD&#41;&#58; summary of NICE guidance"
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                        0 => array:2 [
                          "etal" => false
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                        "tituloSerie" => "BMJ"
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                          0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease"
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                        "paginaInicial" => "1388"
                        "paginaFinal" => "1402"
                        "link" => array:1 [
                          0 => array:2 [
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                          ]
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              "identificador" => "bib0460"
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                0 => array:2 [
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                          "etal" => false
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                        "tituloSerie" => "Obes Rev"
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                        "paginaInicial" => "442"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
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                ]
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              "identificador" => "bib0465"
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                0 => array:2 [
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                      "titulo" => "DASH dietary pattern and cardiometabolic outcomes&#58; an umbrella review of systematic reviews and meta-analyses"
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                            2 => "S&#46;K&#46; Nishi"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutritional approaches for the management of nonalcoholic fatty liver disease&#58; an evidence-based review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Parra-Vargas"
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                            2 => "J&#46;C&#46; Jimenez-Chillaron"
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                  "host" => array:1 [
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              "identificador" => "bib0475"
              "etiqueta" => "29"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to the Dietary Approaches to Stop Hypertension &#40;DASH&#41; diet is associated with lower presence of non-alcoholic fatty liver disease in middle-aged and elderly adults"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "M&#46;L&#46; Xiao"
                            1 => "J&#46;S&#46; Lin"
                            2 => "Y&#46;H&#46; Li"
                            3 => "M&#46; Liu"
                            4 => "Y&#46;Y&#46; Deng"
                            5 => "C&#46;Y&#46; Wang"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Public Health Nutr"
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                        "volumen" => "23"
                        "paginaInicial" => "674"
                        "paginaFinal" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31566148"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0480"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to the Dietary Approaches to Stop Hypertension &#40;DASH&#41; and risk of nonalcoholic fatty liver disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Hekmatdoost"
                            1 => "A&#46; Shamsipour"
                            2 => "M&#46; Meibodi"
                            3 => "N&#46; Gheibizadeh"
                            4 => "T&#46; Eslamparast"
                            5 => "H&#46; Poustchi"
                          ]
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                    0 => array:2 [
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                        "tituloSerie" => "Int J Food Sci Nutr"
                        "fecha" => "2016"
                        "volumen" => "67"
                        "paginaInicial" => "1024"
                        "paginaFinal" => "1029"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27436528"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diet quality association with nonalcoholic fatty liver disease by cirrhosis status&#58; the multiethnic cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;Y&#46; Park"
                            1 => "M&#46; Noureddin"
                            2 => "C&#46; Boushey"
                            3 => "L&#46;R&#46; Wilkens"
                            4 => "V&#46;W&#46; Setiawan"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cdn/nzaa024"
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Dev Nutr"
                        "fecha" => "2020"
                        "volumen" => "4"
                        "paginaInicial" => "nzaa024"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32190810"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0490"
              "etiqueta" => "32"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary factors in relation to liver fat content&#58; a cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Watzinger"
                            1 => "T&#46; Nonnenmacher"
                            2 => "M&#46; Grafetst&#228;tter"
                            3 => "S&#46;A&#46; Sowah"
                            4 => "C&#46;M&#46; Ulrich"
                            5 => "H&#46;U&#46; Kauczor"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Nutrients"
                        "fecha" => "2020"
                        "volumen" => "12"
                        "paginaInicial" => "825"
                      ]
                    ]
                  ]
                ]
              ]
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            32 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of DASH diet on weight loss and metabolic status in adults with non-alcoholic fatty liver disease&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Razavi Zade"
                            1 => "M&#46;H&#46; Telkabadi"
                            2 => "F&#46; Bahmani"
                            3 => "B&#46; Salehi"
                            4 => "S&#46; Farshbaf"
                            5 => "Z&#46; Asemi"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/liv.12990"
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                        "tituloSerie" => "Liver Int"
                        "fecha" => "2016"
                        "volumen" => "36"
                        "paginaInicial" => "563"
                        "paginaFinal" => "571"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26503843"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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              "identificador" => "bib0500"
              "etiqueta" => "34"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Kirk"
                            1 => "D&#46;N&#46; Reeds"
                            2 => "B&#46;N&#46; Finck"
                            3 => "S&#46;M&#46; Mayurranjan"
                            4 => "B&#46;W&#46; Patterson"
                            5 => "S&#46; Klein"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2009.01.048"
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                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2009"
                        "volumen" => "136"
                        "paginaInicial" => "1552"
                        "paginaFinal" => "1560"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19208352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0505"
              "etiqueta" => "35"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beneficial effects of the ketogenic diet on nonalcoholic fatty liver disease&#58; a comprehensive review of the literature"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Watanabe"
                            1 => "R&#46; Tozzi"
                            2 => "R&#46; Risi"
                            3 => "D&#46; Tuccinardi"
                            4 => "S&#46; Mariani"
                            5 => "S&#46; Basciani"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/obr.13024"
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                        "tituloSerie" => "Obes Rev"
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                        "volumen" => "21"
                        "paginaInicial" => "e13024"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32207237"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0510"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;K&#46; Luukkonen"
                            1 => "S&#46; Dufour"
                            2 => "K&#46; Lyu"
                            3 => "X&#46;M&#46; Zhang"
                            4 => "A&#46; Hakkarainen"
                            5 => "T&#46;E&#46; Lehtim&#228;ki"
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                        "tituloSerie" => "Proc Natl Acad Sci U S A"
                        "fecha" => "2020"
                        "volumen" => "117"
                        "paginaInicial" => "7347"
                        "paginaFinal" => "7354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32179679"
                            "web" => "Medline"
                          ]
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                ]
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                        0 => array:2 [
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                            2 => "B&#46; Jiang"
                            3 => "L&#46;R&#46; Bai"
                            4 => "B&#46; Gu"
                            5 => "S&#46;X&#46; Yan"
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                    0 => array:2 [
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                        "tituloSerie" => "J Obstet Gynaecol Res"
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                        "volumen" => "47"
                        "paginaInicial" => "1145"
                        "paginaFinal" => "1152"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33462940"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Efficacy of a 2-month Very Low-Calorie Ketogenic Diet &#40;VLCKD&#41; compared to a standard low-calorie diet in reducing visceral and liver fat accumulation in patients with obesity"
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                        "tituloSerie" => "Front Endocrinol &#40;Lausanne&#41;"
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                0 => array:2 [
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                      "titulo" => "Very low-carbohydrate ketogenic diet for the treatment of severe obesity and associated non-alcoholic fatty liver disease&#58; the role of sex differences"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            3 => "E&#46; Nulli Migliola"
                            4 => "E&#46;E&#46; Martorelli"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ketogenic hypocaloric diet improves nonalcoholic steatohepatitis"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Belopolsky"
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                            4 => "C&#46;J&#46; Fimmel"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "J Transl Int Med"
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                        "paginaInicial" => "26"
                        "paginaFinal" => "31"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Ketogenic diet-induced elevated cholesterol elevated liver enzymes and potential non-alcoholic fatty liver disease"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Low-carbohydrate ketogenic diets&#44; glucose homeostasis&#44; and nonalcoholic fatty liver disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                        "tituloSerie" => "Curr Opin Clin Nutr Metab Care"
                        "fecha" => "2012"
                        "volumen" => "15"
                        "paginaInicial" => "374"
                        "paginaFinal" => "380"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22617564"
                            "web" => "Medline"
                          ]
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              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet &#8211; a randomised controlled trial"
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                            2 => "S&#46; Petersson"
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                    0 => array:2 [
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                        "volumen" => "3"
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                          0 => array:2 [
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              "identificador" => "bib0550"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of periodic fasting on fatty liver index &#8211; a prospective observational study"
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                          "etal" => true
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                            4 => "N&#46; Steckhan"
                            5 => "A&#46; Michalsen"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Reversion to regular diet with alternate day fasting can cure grade-I non-alcoholic fatty liver disease &#40;NAFLD&#41; in high-fructose-intake-associated metabolic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
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                            2 => "G&#46;K&#46; Megahed"
                            3 => "R&#46;S&#46; Mansour"
                            4 => "M&#46;S&#46; Abdel-Latif"
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                        ]
                      ]
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                  ]
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                    0 => array:1 [
                      "Revista" => array:4 [
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                        "paginaInicial" => "60"
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                    ]
                  ]
                ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of alternate-day fasting on body weight and dyslipidaemia in patients with non-alcoholic fatty liver disease&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Cai"
                            1 => "Y&#46;L&#46; Qin"
                            2 => "Z&#46;Y&#46; Shi"
                            3 => "J&#46;H&#46; Chen"
                            4 => "M&#46;J&#46; Zeng"
                            5 => "W&#46; Zhou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12876-019-1132-8"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Gastroenterol"
                        "fecha" => "2019"
                        "volumen" => "19"
                        "paginaInicial" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31852444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomised controlled trial on the effectiveness and adherence of modified alternate-day calorie restriction in improving activity of non-alcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;I&#46; Johari"
                            1 => "K&#46; Yusoff"
                            2 => "J&#46; Haron"
                            3 => "C&#46; Nadarajan"
                            4 => "K&#46;N&#46; Ibrahim"
                            5 => "M&#46;S&#46; Wong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41598-019-47763-8"
                      "Revista" => array:5 [
                        "tituloSerie" => "Sci Rep"
                        "fecha" => "2019"
                        "volumen" => "9"
                        "paginaInicial" => "11232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31375753"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of Ramadan fasting on body composition&#44; blood pressure glucose metabolism&#44; and markers of inflammation in NAFLD patients&#58; an observational trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Aliasghari"
                            1 => "A&#46; Izadi"
                            2 => "B&#46;P&#46; Gargari"
                            3 => "S&#46; Ebrahimi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/07315724.2017.1339644"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Nutr"
                        "fecha" => "2017"
                        "volumen" => "36"
                        "paginaInicial" => "640"
                        "paginaFinal" => "645"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28922096"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ramadan fasting improves liver function and total cholesterol in patients with nonalcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Ebrahimi"
                            1 => "B&#46;P&#46; Gargari"
                            2 => "F&#46; Aliasghari"
                            3 => "F&#46; Asjodi"
                            4 => "A&#46; Izadi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1024/0300-9831/a000442"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Vitam Nutr Res"
                        "fecha" => "2020"
                        "volumen" => "90"
                        "paginaInicial" => "95"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30932777"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of Ramadan fasting on fatty liver disease severity&#58; a retrospective case control study from Israel"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Mari"
                            1 => "T&#46; Khoury"
                            2 => "M&#46; Baker"
                            3 => "H&#46; Said Ahmad"
                            4 => "F&#46; Abu Baker"
                            5 => "M&#46; Mahamid"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Isr Med Assoc J"
                        "fecha" => "2021"
                        "volumen" => "23"
                        "paginaInicial" => "94"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33595214"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of intermittent fasting on non-alcoholic fatty liver disease&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Yin"
                            1 => "Z&#46; Li"
                            2 => "Y&#46; Xiang"
                            3 => "H&#46; Peng"
                            4 => "P&#46; Yang"
                            5 => "S&#46; Yuan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/fnut.2021.709683"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Nutr"
                        "fecha" => "2021"
                        "volumen" => "8"
                        "paginaInicial" => "709683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34322514"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0590"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vegetarian diet&#44; food substitution&#44; and nonalcoholic fatty liver"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;H&#46; Chiu"
                            1 => "M&#46;N&#46; Lin"
                            2 => "W&#46;H&#46; Pan"
                            3 => "Y&#46;C&#46; Chen"
                            4 => "C&#46;L&#46; Lin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/tcmj.tcmj_109_17"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ci Ji Yi Xue Za Zhi"
                        "fecha" => "2018"
                        "volumen" => "30"
                        "paginaInicial" => "102"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29875591"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0595"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vegetarian diets are associated with selected cardiometabolic risk factors among middle-older aged south Asians in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Jin"
                            1 => "A&#46;M&#46; Kanaya"
                            2 => "N&#46;R&#46; Kandula"
                            3 => "L&#46;A&#46; Rodriguez"
                            4 => "S&#46;A&#46; Talegawkar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jn/nxy217"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nutr"
                        "fecha" => "2018"
                        "volumen" => "148"
                        "paginaInicial" => "1954"
                        "paginaFinal" => "1960"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30418560"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0600"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of lacto-ovo-vegetarian diet vs&#46; standard-weight-loss diet on obese and overweight adults with non-alcoholic fatty liver disease&#58; a randomised clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Garousi"
                            1 => "B&#46; Tamizifar"
                            2 => "M&#46; Pourmasoumi"
                            3 => "A&#46; Feizi"
                            4 => "G&#46; Askari"
                            5 => "C&#46;C&#46;T&#46; Clark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/13813455.2021.1887265"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Physiol Biochem"
                        "fecha" => "2021"
                        "paginaInicial" => "1"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33632048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0605"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vegan diet advice might benefit liver enzymes in nonalcoholic fatty liver disease&#58; an open observational pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Chiarioni"
                            1 => "S&#46;L&#46; Popa"
                            2 => "A&#46; Dalbeni"
                            3 => "C&#46; Senore"
                            4 => "D&#46;C&#46; Leucuta"
                            5 => "L&#46; Baroni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15403/jgld-3064"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastrointestin Liver Dis"
                        "fecha" => "2021"
                        "volumen" => "30"
                        "paginaInicial" => "81"
                        "paginaFinal" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33548123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0610"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A vegetarian diet does not protect against nonalcoholic fatty liver disease &#40;NAFLD&#41;&#58; a cross-sectional study between Buddhist priests and the general population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;H&#46; Choi"
                            1 => "D&#46;J&#46; Oh"
                            2 => "K&#46;H&#46; Kwon"
                            3 => "J&#46;K&#46; Lee"
                            4 => "M&#46;S&#46; Koh"
                            5 => "J&#46;H&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5152/tjg.2015.0046"
                      "Revista" => array:6 [
                        "tituloSerie" => "Turk J Gastroenterol"
                        "fecha" => "2015"
                        "volumen" => "26"
                        "paginaInicial" => "336"
                        "paginaFinal" => "343"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26039004"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0615"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Higher adherence to plant-based diets are associated with lower likelihood of fatty liver"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Mazidi"
                            1 => "A&#46;P&#46; Kengne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2018.08.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nutr"
                        "fecha" => "2019"
                        "volumen" => "38"
                        "paginaInicial" => "1672"
                        "paginaFinal" => "1677"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30578029"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0620"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based clinical advice for nutrition and dietary weight loss strategies for the management of NAFLD and NASH"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;J&#46; Hydes"
                            1 => "S&#46; Ravi"
                            2 => "R&#46; Loomba"
                            3 => "E&#46;M&#46; Gray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3350/cmh.2020.0067"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Mol Hepatol"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "paginaInicial" => "383"
                        "paginaFinal" => "400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32674529"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0625"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome&#58; a randomized controlled pilot-study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Boers"
                            1 => "F&#46;A&#46; Muskiet"
                            2 => "E&#46; Berkelaar"
                            3 => "E&#46; Schut"
                            4 => "R&#46; Penders"
                            5 => "K&#46; Hoenderdos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1476-511X-13-160"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lipids Health Dis"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25304296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0630"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hype or reality&#58; should patients with metabolic syndrome-related NAFLD be on the Hunter-Gatherer &#40;Paleo&#41; diet to decrease morbidity&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Tarantino"
                            1 => "V&#46; Citro"
                            2 => "C&#46; Finelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15403/jgld.2014.1121.243.gta"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastrointestin Liver Dis"
                        "fecha" => "2015"
                        "volumen" => "24"
                        "paginaInicial" => "359"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26405708"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0635"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paleolithic nutrition for metabolic syndrome&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;W&#46; Manheimer"
                            1 => "E&#46;J&#46; van Zuuren"
                            2 => "Z&#46; Fedorowicz"
                            3 => "H&#46; Pijl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3945/ajcn.115.113613"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "2015"
                        "volumen" => "102"
                        "paginaInicial" => "922"
                        "paginaFinal" => "932"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26269362"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0640"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Strong and persistent effect on liver fat with a Paleolithic diet during a two-year intervention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Otten"
                            1 => "C&#46; Mellberg"
                            2 => "M&#46; Ryberg"
                            3 => "S&#46; Sandberg"
                            4 => "J&#46; Kullberg"
                            5 => "B&#46; Lindahl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                        "fecha" => "2016"
                        "volumen" => "40"
                        "paginaInicial" => "747"
                        "paginaFinal" => "753"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0645"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Ryberg"
                            1 => "S&#46; Sandberg"
                            2 => "C&#46; Mellberg"
                            3 => "O&#46; Stegle"
                            4 => "B&#46; Lindahl"
                            5 => "C&#46; Larsson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/joim.12048"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intern Med"
                        "fecha" => "2013"
                        "volumen" => "274"
                        "paginaInicial" => "67"
                        "paginaFinal" => "76"
                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes&#58; a randomised controlled trial"
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                    0 => array:2 [
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                        "tituloSerie" => "Hepatol Res"
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                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Lifestyle recommendations for the prevention and management of metabolic syndrome&#58; an international panel recommendation"
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                          0 => array:2 [
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Article information
ISSN: 02149168
Original language: English
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