**Association between Diet Quality and Index of Non-Alcoholic Steatohepatitis in a Large Population of People with Type 2 Diabetes: Data from the TOSCA.IT Study**

**Marilena Vitale 1,†, Giuseppe Della Pepa 1,†, Giuseppina Costabile 1, Lutgarda Bozzetto 1, Paola Cipriano 1, Stefano Signorini 2, Valerio Leoni 2,3, Gabriele Riccardi 1, Olga Vaccaro 1,\* and Maria Masulli <sup>1</sup>**


**\*** Correspondence: ovaccaro@unina.it; Tel.: +39-081-746-3665

† These authors contributed equally to this work.

**Abstract:** Background: There are still open questions with respect to the optimal dietary treatment in patients with type 2 diabetes (T2D) and coexisting non-alcoholic steatohepatitis (NASH). The aim of this study is to investigate, in patients with T2D, the association between NASH, dietary component intake, food groups and adherence to the Mediterranean diet. Methods: Cross-sectional analysis of 2026 people with T2D (1136 men and 890 women). The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. NASH was identified by the Index Of NASH (ION). Based on the cluster analysis two dietary patterns were identified: the NASH and the NO-NASH pattern. Results: The macronutrient composition of the diet was similar in the two patterns. However, the NASH pattern compared with the NO-NASH pattern was characterized by a significantly lower content of fibre (*p* < 0.001), β-carotene (*p* < 0.001), vitamin C (*p* < 0.001), vitamin E (*p* < 0.001), polyphenols (*p* = 0.026) and antioxidant capacity (*p* < 0.001). With regard to food consumption, the NASH pattern compared with NO-NASH pattern was characterized by higher intake of rice (*p* = 0.021), potatoes (*p* = 0.013), red (*p* = 0.004) and processed meat (*p* = 0.003), and a lower intake of wholegrain bread (*p* = 0.019), legumes and nuts (*p* = 0.049), vegetables (*p* = 0.047), fruits (*p* = 0.002), white meat (*p* = 0.001), fatty fish (*p* = 0.005), milk and yogurt (*p* < 0.001). Conclusions: NO-NASH dietary pattern was characterized by a food consumption close to the Mediterranean dietary model, resulting in a higher content of polyphenols, vitamins, and fibre. These finding highlight the potential for dietary components in the prevention/treatment of NASH in people with T2D.

**Keywords:** type 2 diabetes; NASH; micronutrients; macronutrients; dietary habits; foods groups; Mediterranean diet; dietary patterns
