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

Inclusion Criteria: * Age between 40 and 60 years * Diagnosis of NAFLD by ultrasound * BMI ≥ 27 and \< 40 kg/m2 * Meeting at least 3 of 5 criteria for the metabolic syndrome \[as described in the International Diabetes Federation consensus\]: (1) BMI \>30kg/m² or increased waist circumference: ≥ 94 cm in males; ≥ 80 cm in females; (2) Triglycerides (TG) levels ≥ 150 mg/dL (1.7 mmol/L) or specific treatment; (3) Reduced HDL cholesterol: \< 40 mg/dL (1.03 mmol/L) in males; \< 50 mg/dL (1.29 mmol/L) in females or specific treatment; (4) Raised blood pressure: systolic BP ≥ 130 or diastolic BP ≥ 85 mm Hg or treatment of previously diagnosed hypertension; (5) Raised fasting plasma glucose (FPG) ≥ 100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes * Written informed consent Exclusion Criteria: * Inability or unwillingness to give informed consent or communicate with staff study * Documented history of prior cardiovascular disease \[angina; myocardial infarction; coronary revascularization procedures; stroke (ischemic or hemorrhagic including transient ischemic attacks); symptomatic peripheral artery disease that required surgery or was diagnosed with vascular imaging techniques; ventricular arrhythmia; uncontrolled atrial fibrillation; congestive heart failure (New York Heart Association Class III or IV); hypertrophic myocardiopathy; and history of aortic aneurism \>=5.5cm in diameter or aortic aneurism surgery\] * Documented history of prior liver diseases (other than NAFLD) * Active cancer or a history of malignancy in the last 5 years * Low predicted probability to change food habits according to the Stages of Change Model (Nigg, 1999) * Unwillingness or inability to adhere to the dietary and physical activity intervention over the entire period of the study * Failure to follow scheduled visits * Weight loss (\>5 kg) during 6 months prior to visit * Previous surgical procedures for weight loss or scheduled bariatric surgery within the next 12 months * Use of weight loss medications during 6 months prior to visit * Previous history of bowel resection, inflammatory bowel disease * Obesity associated with endocrine disease (except treated hypothyroidism) * Allergy to Mediterranean diet foods or components * Severe psychiatric disorders (schizophrenia, bipolar disorder, eating disorders, or depression with hospitalization within the last 6 months) or Beck Depression Inventory score \> 30 * Severe condition with less than 24 months life expectancy * Chronic abuse of drugs or alcohol (\>21 and \>14 units of alcohol a week for men and women, respectively; 1 unit = 125 mL of wine) * Treatment with steroids * Pregnancy