Dietary Interventions in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Narrative Review of Evidence, Mechanisms, and Translational Challenges

Top Things to Know

These diets act as “prescriptions” for liver health, reducing fat accumulation and systemic inflammation while improving cardiometabolic outcomes.

Structured calorie reduction and time-restricted eating can be leveraged as non-pharmacologic treatments to improve liver function.

Resistant starch, legumes, and synbiotic supplementation highlight the potential of gut-focused dietary prescriptions.

Summary of Conclusion/Findings

This narrative review examined dietary interventions for managing metabolic dysfunction-associated steatotic liver disease (MASLD) and its advanced form, MASH. Evidence shows that Mediterranean and plant-forward diets consistently reduce intrahepatic fat and improve insulin sensitivity, while Western diets and ultra-processed foods exacerbate lipotoxicity and inflammation. Specific strategies such as resistant starch supplementation and bean-based diets demonstrated benefits through gut microbiome modulation and reduced systemic inflammation. Time-restricted eating improved hepatic steatosis and metabolic markers, particularly when paired with spontaneous calorie reduction, though benefits were similar to standard calorie restriction under controlled conditions. Weight loss remains the most effective intervention for improving liver health, regardless of whether achieved through lifestyle or pharmacologic means. Emerging microbiome-targeted approaches (e.g., probiotics, synbiotics, fecal microbiota transplantation) show promise but require further research, and future directions emphasize precision nutrition and culturally tailored interventions for equitable implementation.