Mediterranean Diet for Fatty Liver: Foods and a Sample Day

The Mediterranean diet for fatty liver means eating mostly vegetables, fruit, legumes, whole grains, nuts, fish and olive oil. It also means less sugar, refined carbs, saturated fat, ultra-processed food and red or processed meat. The main US and European liver guidelines favor it because it is linked to less liver fat and better heart health.

It is a pattern, not a fixed menu, so dal and roti, grilled fish and hummus, fish sinigang or beans and tortillas can all fit. Fatty liver here means MASLD, which replaced the older name non-alcoholic fatty liver disease (NAFLD), so you may also see this called the Mediterranean diet for NAFLD.

What is the Mediterranean diet for fatty liver?

The 2024 European liver, diabetes and obesity guidelines (EASL, EASD and EASO) describe the diet. It is high in olive oil, vegetables, fruits, nuts and seeds, legumes, whole grains, fish and seafood. It cuts back on four things that observational studies link to fatty liver: sugars and refined carbohydrates, saturated fat, ultra-processed foods, and red and processed meat.

Eat more often	Eat less often
Vegetables	Sugar, sweets and sugary drinks
Whole fruit (not juice)	Refined carbs, such as white bread
Legumes: beans, lentils, chickpeas	Saturated fat: butter, ghee, lard, fatty meat
Whole grains	Ultra-processed food, such as chips, cookies and candy
Nuts and seeds	Red meat and processed meat
Fish and seafood
Olive oil, in place of butter or ghee

Sources: EASL-EASD-EASO 2024; NHS (saturated fat foods); Dietary Guidelines for Americans 2025-2030 (refined carb and processed food examples).

For more on what to limit, see foods to avoid with fatty liver.

Why liver guidelines recommend a Mediterranean diet

The US guidance (AASLD, 2023). For overweight people with fatty liver, the American Association for the Study of Liver Diseases advises a diet that creates a calorie deficit. Where possible, it favors diets lower in carbohydrates and saturated fat and rich in fiber and unsaturated fats, such as a Mediterranean diet, for their added heart benefits. AASLD notes that heart and blood vessel disease is an important cause of death in people with fatty liver.

The European guidelines (EASL, 2024). EASL strongly recommends improving diet quality along Mediterranean lines, limiting ultra-processed food and avoiding sugary drinks, to improve liver injury. It says the diet has repeatedly been shown to benefit the liver and the heart, even without weight loss.

It is not the only option. AASLD says low-carb, low-fat, Mediterranean and other diets appear comparable for improving fatty liver, and that whether the Mediterranean diet beats the others in small trials is debated. It still favors it, noting that it is sustainable and good for the heart. EASL says calorie-reduced low-carb and low-fat diets appear similarly effective at lowering liver fat, but the Mediterranean diet seems to add extra benefit and may be easier to keep up. EASL also notes there is little evidence so far that a better diet improves long-term liver outcomes.

NIDDK and the NHS give similar advice. Neither names the Mediterranean diet. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says your doctor may suggest swapping saturated and trans fats for unsaturated fats. It also mentions more foods with a low glycemic index, like most fruits and vegetables and whole grains, and avoiding foods and drinks high in simple sugars.

The NHS says to eat a healthy, balanced diet. Its Eatwell Guide includes at least 5 portions of fruit and vegetables a day, wholegrain or higher-fiber starchy foods, and beans, pulses and fish. It also advises less red and processed meat and small amounts of unsaturated oil. So a healthy, balanced diet for fatty liver and a Mediterranean diet overlap a lot.

How to follow it with the foods you already eat

AASLD notes that the Mediterranean diet may not translate directly to every culture, and that similar changes suited to your culture and tastes may help you stick with them. EASL adds that taking your preferences, culture and budget into account can improve long-term adherence.

The food ideas below are our suggestions, matched to the food groups above. The guidelines do not name these dishes.

South Asia: roti, dal and rice

• Roti: make whole-wheat roti (chapati) your everyday bread. The 2020-2025 Dietary Guidelines count whole-wheat chapati as a whole grain. Have paratha and puri, which use more fat, now and then rather than daily.
• Dal: dal, chana and rajma are legumes. The NHS suggests pulses such as beans, peas and lentils in place of meat, since they are low in fat and provide fiber and protein.
• Rice: brown rice is a whole grain. White rice, including white basmati, is refined and on NIDDK’s list of high glycemic index foods, so keep portions modest. See is rice good for fatty liver.
• Ghee and chai: cook with a little olive, canola or sunflower oil instead of ghee, which the NHS lists among foods high in saturated fat. NIDDK names sweetened tea as a source of fructose, so take chai with less sugar or none.
• No fish? Lean on legumes, nuts, seeds and low-fat dahi, which are all on EASL’s lists.

The Gulf: dates, hummus and grilled fish

• Grilled fish: grilled fish with salad fits this pattern well. The NHS calls steamed, baked or grilled fish healthier than fried, and notes that frying can add fat.
• Hummus, foul and lentil soup: hummus (chickpeas), foul (fava beans) and lentil soup are all legume dishes, and hummus adds tahini (sesame paste) and often olive oil. Eat it with vegetables or whole-wheat bread.
• Dates: the NHS counts 30 g of dried fruit, such as dates, as one of your 5 A Day. It advises eating dried fruit at mealtimes, not between meals, to protect your teeth. Dates are very sweet, so we suggest a few with a meal rather than a bowlful. More in fruits for fatty liver.
• Kabsa and karak: with rice dishes such as kabsa, machboos or mandi, take less rice and more salad, and choose chicken or fish over fatty lamb more often. Karak is usually sweetened, so ask for less sugar or none.

The Philippines: rice, fish and vegetables

• Fish: inihaw na isda (grilled fish) and fish sinigang with vegetables fit this pattern well. The NHS advises at least 2 portions of fish a week (about 140 g each), 1 of them oily, such as sardines. Its advice may be different if you are pregnant.
• Vegetables and monggo: pinakbet, kangkong, malunggay and ampalaya add vegetables, and ginisang monggo is a mung bean (legume) dish.
• Rice: keep servings modest, and try brown rice or half brown, half white.
• Go easy on: soft drinks, and processed meats such as longganisa, tocino and hotdogs, which EASL says to cut back on. The NHS lists coconut oil and coconut cream among foods high in saturated fat.

Mexico: beans, corn tortillas and avocado

• Beans: frijoles de olla (whole beans simmered in a pot) are an easy way to eat legumes. Refried beans are often fried in lard, which the NHS lists among foods high in saturated fat, so use a little oil or keep them occasional.
• Corn tortillas: they can stay, in modest numbers. The 2020-2025 Dietary Guidelines count masa, the corn dough used for tortillas, as a refined grain, and the current edition names flour tortillas among refined carbs to cut back on. Fill your tortillas with beans, nopales, vegetables and grilled fish or chicken.
• Avocado: the NHS lists avocado as a source of monounsaturated fat, a healthier type of fat, and the current Dietary Guidelines name avocados among whole foods with healthy fats. All fats are high in calories, so if you are losing weight, a few slices go further than a big bowl of guacamole.
• Go easy on: chorizo and other processed meats, pan dulce, sodas and sweetened aguas frescas. The Dietary Guidelines say to avoid sugary drinks such as sodas and fruit drinks.

A simple one-day fatty liver meal plan

This example day is our suggestion, built only on the principles above. It is not a calorie plan. The 2025-2030 Dietary Guidelines say calorie needs vary with age, sex, height, weight and activity, and AASLD advises a calorie deficit if you are overweight.

Meal	Example	Principle behind it
Breakfast	Oats with plain low-fat yogurt or milk, fresh fruit and a few unsalted nuts. Tea or coffee without sugar.	Whole grains, whole fruit, nuts and low-fat dairy (EASL). No sweetened tea (NIDDK).
Lunch	Dal, chana or beans with a large serving of vegetables and a modest portion of whole-wheat roti or brown rice.	Legumes, vegetables and whole grains (EASL).
Snack	A piece of fruit, or carrot and cucumber sticks with hummus.	Whole fruit, not juice; vegetables and legumes (EASL).
Dinner	Grilled or baked fish with salad and vegetables cooked in a little olive or canola oil.	Fish and olive oil (EASL). Grilled, not fried, and unsaturated oil in small amounts (NHS).
Drinks	Water, plain tea or coffee.	No sugary drinks and no alcohol (EASL).

Oats count as a whole grain in the 2020-2025 Dietary Guidelines, like brown rice and whole-wheat roti.

Same day, other kitchens (also our suggestions):

• The Gulf: foul or lentil soup for lunch, grilled fish with fattoush for dinner, a few dates with a meal.
• The Philippines: ginisang monggo with vegetables and a little rice, then inihaw na isda or fish sinigang.
• Mexico: frijoles de olla with nopales and corn tortillas, then grilled fish with salad.

Weight, exercise and alcohol

If you are overweight. EASL aims for a lasting loss of at least 5% of body weight to reduce liver fat, 7% to 10% to improve inflammation and 10% or more to improve scarring (fibrosis). NIDDK says doctors recommend losing weight gradually. It warns that losing weight fast, or becoming malnourished, can make liver disease worse. More in weight loss for fatty liver.

If you are not overweight. Fatty liver can affect people who are not overweight too, and AASLD notes that lean people with fatty liver are more often of Hispanic or Asian origin. EASL still recommends diet and exercise to lower liver fat. It also notes lower body mass index (BMI) cut-offs for Asian people: 23 to 24.9 is overweight and 25 or more is obesity.

Move more. The NHS suggests at least 150 minutes of exercise a week. EASL recommends activity suited to what you like and can do, preferably more than 150 minutes of moderate or 75 minutes of vigorous activity a week. Both AASLD and EASL say exercise benefits the liver even without weight loss.

Leave out the wine. EASL’s description of the diet includes no alcohol, and it advises people with fatty liver against drinking. It says anyone with advanced fibrosis or cirrhosis should stop completely, and AASLD says the same for stage 2 fibrosis or higher. NIDDK says to minimize alcohol. The NHS gives a limit of no more than 14 units a week, but treat that as a ceiling, not a safe amount for you. The liver guidelines are stricter, so we suggest not drinking at all.

When to talk to your doctor

Talk to your doctor or a dietitian before big diet changes, especially if:

• You have diabetes or another long-term condition. The 2025-2030 Dietary Guidelines advise asking your health care professional whether the guidelines need adapting for you.
• You have fibrosis or cirrhosis. The NHS says this level of liver damage needs a liver specialist. AASLD says cirrhosis calls for an approach that puts protein first. EASL recommends a high-protein diet and a late-evening snack for people with muscle loss or decompensated (more advanced) cirrhosis. Do not cut back on food on your own.
• You are thinking about supplements or herbal remedies. NIDDK advises checking with your doctor first, for safety, and warns that some herbal remedies can damage the liver. EASL says supplements cannot be recommended for fatty liver, as there is not enough evidence that they work or are safe.
• You have not been checked. The NHS advises seeing a GP (family doctor) if you think you could have fatty liver or are at higher risk. After a diagnosis, it advises check-ups at least once a year.

Liverleaf, the fatty liver diet app we are building, is still in development. Until it launches, our fatty liver diet guides cover more everyday foods.

This article is for general information and is not medical advice. Talk to your doctor before changing your diet, especially if you have a health condition.