Mediterranean, plant-based diets vital in MASLD management

Dietary interventions continue to provide benefits in the management of chronic liver diseases and serve as a valuable addition to pharmacotherapy options available, reports a study.

“While existing strategies, such as Mediterranean-style diets, time-restricted eating, and microbiome modulation, demonstrate meaningful short-term benefits, sustained impact on fibrosis and long-term outcomes remains a critical research frontier,” said the investigators, who conducted a systematic search of studies on dietary modifications and metabolic dysfunction-associated steatotic liver disease (MASLD).

The databases of PubMed and Science Direct were accessed up to 10 July 2025. Data extracted from the studies included the types of interventions, outcomes related to liver health, and research limitations.

Pooled results showed consistent improvements in hepatic and metabolic outcomes with dietary interventions. For instance, a Mediterranean diet reduced hepatic steatosis by 39 percent and improved insulin sensitivity in a randomized controlled trial (RCT) involving 259 patients for 12 weeks.

A calorie-restricted lifestyle program in adults with MASLD (n=196) resulted in a 25-percent decrease in liver fat over 52 weeks, while a resistant starch supplementation (n=200) reduced intrahepatic triglyceride content by 8 percent via gut microbiome modulation. [Nutrients 2025;17:3491]

Furthermore, a pilot RCT of medically tailored meals in cirrhosis (n=40) led to fewer ascites symptoms and better quality of life, while prebiotic supplementation in MASLD (n=200) decreased systemic inflammation and increased immune-regulating microbes.

On the other hand, Western dietary patterns and ultraprocessed foods showed consistent associations with lipotoxicity and inflammation.

“Across trials and systematic reviews, Mediterranean and plant-forward patterns consistently reduce intrahepatic fat, while Western dietary patterns … promote lipotoxicity, hepatic inflammation, and progression risk,” the investigators said.

“Select nutrient-focused strategies (eg, vitamin E for carefully chosen nondiabetic adults with biopsy-proven disease) can reduce steatosis and lobular inflammation, though antifibrotic effects are less consistent,” they added.

When to eat

Apart from what food to eat, the timing of meals is also essential. Thus, time-restricted eating (TRE) may help improve weight, metabolic biomarkers, and circadian alignment in MASLD. TRE can be a valuable addition to calorie restriction and potentially relieve hepatic steatosis, according to the investigators.

“Looking ahead, multi-omics and precision nutrition—integrating metagenomics, metabolomics, and epigenomics—are beginning to identify mechanistic signatures (eg, short-chain fatty acids, bile-acid derivatives) that can stratify patients, monitor response, and guide targeted diet–microbiome interventions,” they noted.

A pragmatic care model highlights the following: (1) Mediterranean/plant-forward eating with minimal ultraprocessed foods, (2) TRE to reinforce circadian and metabolic health, (3) structured weight-loss support, (4) microbiome-informed strategies guided by omics-derived biomarkers. Further studies are warranted to confirm histologic and antifibrotic benefits.

“Collectively, these findings support an integrative lifestyle medicine framework for MASLD/metabolic dysfunction-associated steatohepatitis that positions dietary quality, meal timing, and metabolic–behavioural alignment as interconnected therapeutic pillars,” the investigators said.

“At its core, this model prioritizes Mediterranean and plant-forward dietary patterns as the foundational approach to reduce intrahepatic fat, systemic inflammation, and cardiometabolic risk,” they added.