Meir AY, Rinott E, Tsaban G., et al. - In the present study, researchers sought to test the efficacy of green-Mediterranean (MED) diet, which further restricts red/processed meat and augments green plants and polyphenols, on non-alcoholic fatty liver disease (NAFLD), reflected by loss of intrahepatic fat (IHF). For the DIRECT-PLUS 18-month randomized clinical trial, 294 candidates with abdominal obesity/dyslipidemia were assigned into healthy dietary guidelines, MED and green-MED weight-loss diet groups, all with physical activity. Among the participants (age = 51 years; 88% men; BMI = 31.3 kg/m²; median IHF% = 6.6%; mean = 10.2%; 62% with NAFLD) there was an 89.8% 18-month retention-rate and 78% had eligible follow-up magnetic resonance spectroscopy. The latest proposed green-Mediterranean diet strategy, amplified with green plant-based proteins/polyphenols such as Mankai, green tea, and walnuts and limited to red/processed meat, will double the loss of IHF compared with other balanced nutritional strategies and minimize NAFLD by half. NAFLD prevalence in these groups dropped 54.8% (HDG), 47.9% (MED) and 31.5% (green-MED). Compared to MED and HDG, green-MED group achieved almost double IHF% loss in spite of comparable moderate weight-loss in both MED groups. Increased Mankai and walnuts intake, decreased red/processed meat consumption, improved serum folate and adipokines/lipids biomarkers, changes in microbiome composition (beta-diversity) and specific bacteria were independently linked with IHF% loss.