Mediterranean, fasting or DASH? Exploring promising metabolic benefits for management of MASLD

Imagine a condition affecting nearly one-third of the global population, often silently progressing, and deeply intertwined with prevalent health issues like obesity and type 2 diabetes. This is metabolic dysfunction-associated steatotic liver disease, or MASLD, previously known as non-alcoholic fatty liver disease (NAFLD). It’s characterized by an excessive accumulation of fat in the liver, which can lead to more severe liver pathologies, including inflammation, fibrosis, and even liver cancer.

Given its rising prevalence and strong links to other cardiometabolic diseases, MASLD presents a significant global health challenge. While pharmacological treatments are emerging, lifestyle and dietary modifications remain the cornerstone of MASLD management. Our recent systematic review published in Nutrients dives deeply into how various dietary patterns can impact MASLD and its coexisting conditions, offering insights into effective strategies for better health outcomes.

MASLD is a complex condition driven by a combination of genetic, environmental, and lifestyle factors. Its diagnosis hinges on the presence of hepatic steatosis alongside at least one cardiometabolic risk factor, such as obesity, dyslipidemia, insulin resistance, or type 2 diabetes.

Patients often exhibit a range of clinical parameters, including altered body mass index (BMI), waist circumference, impaired glucose metabolism (like elevated fasting glucose and insulin resistance), unfavorable lipid profiles, and increased inflammatory markers. These underlying metabolic disturbances highlight the importance of holistic management approaches that address not only liver health but also overall metabolic well-being.

Our review specifically looked at randomized controlled trials (RCTs) published between January 2019 and September 2024, focusing on adult patients with MASLD, either alone or with co-existing conditions like obesity, metabolic syndrome, and type 2 diabetes.

Among the most effective dietary models we investigated, the Mediterranean diet (MED) stands out. This dietary pattern, originating from traditional eating habits around the Mediterranean Sea, is rich in fruits, vegetables, whole grains, nuts, olive oil, and emphasizes moderate intake of fish and poultry, while limiting red meat and processed foods. Its unique composition, dense in nutrients and relatively low in calories, promotes sustainable weight loss and can reduce central adiposity.

Our findings show that MED-based interventions significantly reduce body weight, BMI, and waist circumference. Beyond anthropometric improvements, MED also positively influences glycemic metabolism and inflammatory status, leading to improvements in fasting glucose, insulin, and inflammatory markers like hs-CRP. Although more data are needed on liver function, early indications suggest MED-based interventions can improve hepatic outcomes by decreasing liver enzymes (such as AST and ALT) and MASLD severity biomarkers.

Intermittent fasting (IF) approaches, specifically alternate-day fasting (ADF) and time-restricted feeding (TRF) (e.g., the 16/8 protocol), also show considerable promise. These strategies involve specific eating windows followed by periods of fasting.

Our review demonstrated that IF can be effective in improving anthropometric measures like body weight, BMI, and body fat, as well as optimizing fasting glucose, triglycerides, and LDL-C, and reducing inflammation (hs-CRP). Furthermore, TRF, particularly the 16/8 protocol, showed more pronounced effects on cardiometabolic outcomes in MASLD patients and contributed to improvements in liver function, evidenced by reduced hepatic enzymes (AST and ALT) and decreased liver stiffness. The benefits of IF are attributed to its role in glucose utilization and a metabolic switch from glucose to ketones during fasting, which ultimately helps reduce fat accumulation in liver tissues.

Beyond MED and IF, other dietary patterns offer additional benefits. The Dietary Approaches to Stop Hypertension (DASH) diet, typically designed for blood pressure management, was also found to reduce anthropometric measures and improve immune-metabolic parameters such as fasting glucose, insulin levels, and triglycerides.

The lacto-ovo-vegetarian diet (LOV-D) similarly showed potential in reducing anthropometric measures and positively influencing liver function by reducing hepatic enzymes and fibrosis biomarkers. These diets, by promoting nutrient-rich foods and limiting processed items, contribute to overall metabolic health and can significantly impact MASLD outcomes.

Our systematic review clearly highlights the potential of various dietary interventions in the management of MASLD and its common co-existing conditions. While the Mediterranean diet and intermittent fasting appear particularly promising for improving anthropometric measures, glycemic control, and reducing inflammation, with potential benefits for liver function, other diets like DASH and the lacto-ovo-vegetarian diet also offer significant advantages.

However, it is crucial to acknowledge that despite these encouraging findings, further long-term studies are needed to confirm these effects and better understand the underlying mechanisms. Such research will be vital in optimizing dietary protocols and ensuring their safety and efficacy for individuals living with MASLD

This story is part of Science X Dialog, where researchers can report findings from their published research articles. Visit this page for information about Science X Dialog and how to participate.

Imagine a condition affecting nearly one-third of the global population, often silently progressing, and deeply intertwined with prevalent health issues like obesity and type 2 diabetes. This is metabolic dysfunction-associated steatotic liver disease, or MASLD, previously known as non-alcoholic fatty liver disease (NAFLD). It’s characterized by an excessive accumulation of fat in the liver, which can lead to more severe liver pathologies, including inflammation, fibrosis, and even liver cancer.

Given its rising prevalence and strong links to other cardiometabolic diseases, MASLD presents a significant global health challenge. While pharmacological treatments are emerging, lifestyle and dietary modifications remain the cornerstone of MASLD management. Our recent systematic review published in Nutrients dives deeply into how various dietary patterns can impact MASLD and its coexisting conditions, offering insights into effective strategies for better health outcomes.

MASLD is a complex condition driven by a combination of genetic, environmental, and lifestyle factors. Its diagnosis hinges on the presence of hepatic steatosis alongside at least one cardiometabolic risk factor, such as obesity, dyslipidemia, insulin resistance, or type 2 diabetes.

Patients often exhibit a range of clinical parameters, including altered body mass index (BMI), waist circumference, impaired glucose metabolism (like elevated fasting glucose and insulin resistance), unfavorable lipid profiles, and increased inflammatory markers. These underlying metabolic disturbances highlight the importance of holistic management approaches that address not only liver health but also overall metabolic well-being.

Our review specifically looked at randomized controlled trials (RCTs) published between January 2019 and September 2024, focusing on adult patients with MASLD, either alone or with co-existing conditions like obesity, metabolic syndrome, and type 2 diabetes.

Among the most effective dietary models we investigated, the Mediterranean diet (MED) stands out. This dietary pattern, originating from traditional eating habits around the Mediterranean Sea, is rich in fruits, vegetables, whole grains, nuts, olive oil, and emphasizes moderate intake of fish and poultry, while limiting red meat and processed foods. Its unique composition, dense in nutrients and relatively low in calories, promotes sustainable weight loss and can reduce central adiposity.

Our findings show that MED-based interventions significantly reduce body weight, BMI, and waist circumference. Beyond anthropometric improvements, MED also positively influences glycemic metabolism and inflammatory status, leading to improvements in fasting glucose, insulin, and inflammatory markers like hs-CRP. Although more data are needed on liver function, early indications suggest MED-based interventions can improve hepatic outcomes by decreasing liver enzymes (such as AST and ALT) and MASLD severity biomarkers.

Intermittent fasting (IF) approaches, specifically alternate-day fasting (ADF) and time-restricted feeding (TRF) (e.g., the 16/8 protocol), also show considerable promise. These strategies involve specific eating windows followed by periods of fasting.

Our review demonstrated that IF can be effective in improving anthropometric measures like body weight, BMI, and body fat, as well as optimizing fasting glucose, triglycerides, and LDL-C, and reducing inflammation (hs-CRP). Furthermore, TRF, particularly the 16/8 protocol, showed more pronounced effects on cardiometabolic outcomes in MASLD patients and contributed to improvements in liver function, evidenced by reduced hepatic enzymes (AST and ALT) and decreased liver stiffness. The benefits of IF are attributed to its role in glucose utilization and a metabolic switch from glucose to ketones during fasting, which ultimately helps reduce fat accumulation in liver tissues.

Beyond MED and IF, other dietary patterns offer additional benefits. The Dietary Approaches to Stop Hypertension (DASH) diet, typically designed for blood pressure management, was also found to reduce anthropometric measures and improve immune-metabolic parameters such as fasting glucose, insulin levels, and triglycerides.

The lacto-ovo-vegetarian diet (LOV-D) similarly showed potential in reducing anthropometric measures and positively influencing liver function by reducing hepatic enzymes and fibrosis biomarkers. These diets, by promoting nutrient-rich foods and limiting processed items, contribute to overall metabolic health and can significantly impact MASLD outcomes.

Our systematic review clearly highlights the potential of various dietary interventions in the management of MASLD and its common co-existing conditions. While the Mediterranean diet and intermittent fasting appear particularly promising for improving anthropometric measures, glycemic control, and reducing inflammation, with potential benefits for liver function, other diets like DASH and the lacto-ovo-vegetarian diet also offer significant advantages.

However, it is crucial to acknowledge that despite these encouraging findings, further long-term studies are needed to confirm these effects and better understand the underlying mechanisms. Such research will be vital in optimizing dietary protocols and ensuring their safety and efficacy for individuals living with MASLD

This story is part of Science X Dialog, where researchers can report findings from their published research articles. Visit this page for information about Science X Dialog and how to participate.