Abstract
Conventional research mainly focuses on individual nutrients or specific foods in relation to chronic liver disease, but the cumulative effects of dietary patterns are underexplored. This study aimed to assess current evidence on the alternate Mediterranean Diet (aMED) and chronic liver disease risk via a meta-analysis of observational studies. A systematic search of PubMed, Web of Science, Cochrane, and Embase (up to February 2025) identified studies on aMED and chronic liver disease, using predefined criteria for screening, quality assessment, and data extraction. A total of 20 articles (3 cross-sectional, 15 cohort, and 2 case-control; 1,286,480 participants) were analyzed using a random-effects model. The analysis showed that aMED was significantly negatively correlated with chronic liver disease (OR = 0.65, 95% CI: 0.56-0.75), indicating that adherence reduces risk. Subgroup analysis showed aMED's protective effects in North America (OR = 0.67, 95% CI: 0.54-0.83) and Europe (OR = 0.54, 95% CI: 0.44-0.66). The results suggest aMED adherence may lower chronic liver disease risk, emphasizing dietary modifications for prevention.