Researchers studied over 32,000 Korean adults with a common liver condition called fatty liver disease to see if different eating patterns could reduce their risk of dying from heart disease. They found that people who followed a Korean version of the Mediterranean diet—which includes lots of vegetables, fish, and healthy oils—had about 33% lower risk of heart disease death compared to those who ate the least healthy way. This suggests that even people with fatty liver disease can protect their hearts by choosing the right foods, and this benefit appears to work across different cultures, not just in Mediterranean countries.

The Quick Take

  • What they studied: Whether eating patterns affect the risk of dying from heart disease in people who have fatty liver disease
  • Who participated: 32,091 Korean adults aged 40 and older with metabolic dysfunction-associated steatotic liver disease, followed from 2004 to 2013
  • Key finding: People who most closely followed a Korean Mediterranean-style diet had a 33% lower risk of dying from heart disease compared to those who followed it least (hazard ratio 0.67, p=0.048)
  • What it means for you: If you have fatty liver disease, eating more vegetables, fish, and healthy oils while reducing processed foods may help protect your heart. However, this is one study in a Korean population, so talk to your doctor about whether this applies to you personally.

The Research Details

This was a long-term follow-up study that tracked real people over time rather than randomly assigning them to different diets. Researchers started with 32,091 Korean adults aged 40 and older who had fatty liver disease. They asked participants detailed questions about what they ate using a food questionnaire, then used a statistical method called principal component analysis to identify patterns in their eating habits. The researchers then followed these people for several years and tracked who developed heart disease and died from it.

The study adjusted for many other factors that could affect heart disease risk, including age, sex, weight, smoking, alcohol use, exercise, calories eaten, high blood pressure, diabetes, and high cholesterol. This helps ensure that the diet pattern itself—not these other factors—was responsible for the differences in heart disease risk.

This research approach is important because it looks at real people eating their normal diets over many years, rather than asking people to follow a strict diet in a lab. This makes the results more relevant to everyday life. By studying a large group of people with the same liver condition, researchers could see which eating patterns actually protected their hearts.

This study has several strengths: it included a large number of people (over 32,000), followed them for many years, and adjusted for many other health factors. However, the study was conducted only in Korea, so results may not apply equally to other populations. The Mediterranean diet benefit was borderline statistically significant (p=0.048, just barely meeting the standard threshold), meaning there’s a small chance this finding could be due to chance. The study is observational, so it shows association but cannot prove that the diet directly caused the lower risk.

What the Results Show

The main finding was that people who most closely followed a Korean Mediterranean-style diet pattern had significantly lower risk of dying from heart disease. Specifically, those in the highest adherence group had a 33% lower risk compared to those in the lowest group. This means if heart disease death risk was 100 cases in the lowest diet group, it would be about 67 cases in the highest diet group.

The Korean Mediterranean-style diet pattern included foods like vegetables, fish, seafood, legumes, and healthy oils—similar to the traditional Mediterranean diet but adapted to Korean food preferences and availability. This pattern emphasized plant-based foods and lean proteins while limiting processed items.

Interestingly, other dietary patterns studied did not show the same protective effect. These included diets high in processed foods and dairy, diets heavy in animal proteins, grain-based diets, and diets high in refined carbohydrates and unhealthy fats. This suggests that the specific combination of foods in the Mediterranean-style pattern matters more than just eating more of one food group.

The study examined five different dietary patterns total. Besides the Mediterranean-style diet, researchers looked at a processed food and dairy pattern, an animal protein-rich pattern, a grain-based pattern, and a refined carbohydrate and fat-rich pattern. None of these other patterns showed a significant association with reduced heart disease death risk. This finding is important because it shows that not all eating patterns are equally protective for people with fatty liver disease.

Previous research has shown that Mediterranean-style diets protect heart health in the general population. This study extends that finding to people with fatty liver disease and shows the benefit may work across different cultures. The fact that a Korean adaptation of the Mediterranean diet worked well suggests the core principles of the diet (lots of plants, healthy fats, lean proteins) matter more than the specific foods used.

This study has several important limitations. First, it only included Korean adults, so the results may not apply equally to other ethnic groups or countries. Second, the study is observational, meaning researchers watched what people ate naturally rather than assigning them to specific diets, so we cannot be certain the diet caused the lower risk—other unmeasured factors could be involved. Third, the statistical significance was borderline (p=0.048), meaning there’s a small possibility this finding could be due to chance. Fourth, dietary intake was measured only at the beginning of the study, so we don’t know if people’s eating habits changed over time. Finally, the study focused on a specific population with fatty liver disease, so results may not apply to people without this condition.

The Bottom Line

If you have fatty liver disease, consider adopting a Mediterranean-style eating pattern that emphasizes vegetables, fruits, fish, legumes, and healthy oils while limiting processed foods and refined carbohydrates. This approach appears to offer heart protection based on moderate-quality evidence. However, this is one study in a Korean population, so discuss with your doctor whether this applies to your specific situation. Confidence level: Moderate—the finding is promising but needs confirmation in other populations.

This research is most relevant to people with fatty liver disease who are concerned about heart disease risk. It may also interest people with metabolic syndrome or prediabetes, as these conditions often occur together with fatty liver disease. People without fatty liver disease should not assume these results apply to them, though Mediterranean-style diets are generally considered healthy for most people. Anyone with existing heart disease or taking medications should consult their doctor before making major dietary changes.

Heart disease risk reduction from dietary changes typically takes months to years to become apparent. You might notice improvements in energy, weight, or blood sugar levels within weeks to months, but the cardiovascular benefits shown in this study developed over several years of consistent eating patterns. Expect to follow this eating pattern for at least 3-6 months before assessing whether it’s working for you.

Want to Apply This Research?

  • Track daily servings of key Mediterranean-style foods: vegetables (goal: 5+ servings), fish/seafood (goal: 2-3 times per week), legumes (goal: 3-4 times per week), and healthy oils used in cooking. Also track processed food intake to ensure it stays low.
  • Start by adding one Mediterranean-style element to each meal: add vegetables to breakfast, choose fish instead of red meat for lunch, snack on nuts or legumes, and use olive oil for cooking. Gradually reduce processed foods and refined carbohydrates while increasing whole grains and plant-based options.
  • Weekly check-ins on adherence to the Mediterranean pattern, monthly tracking of energy levels and how you feel, and quarterly check-ins with your doctor on liver health markers and heart disease risk factors like blood pressure and cholesterol. Use the app to identify patterns in which foods make you feel best and which dietary choices you can sustain long-term.

This research suggests an association between Mediterranean-style eating and lower heart disease risk in people with fatty liver disease, but it does not prove cause and effect. This study was conducted in Korea and may not apply equally to all populations. If you have fatty liver disease, heart disease, or are taking medications, consult your doctor or registered dietitian before making significant dietary changes. This information is for educational purposes and should not replace professional medical advice. Always discuss major lifestyle changes with your healthcare provider to ensure they’re appropriate for your individual health situation.