Nutritional Strategies for Battling Obesity-Linked Liver Disease: the Role of Medical Nutritional Therapy in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Management

Abstract

Purpose of review: This narrative review explores the role of Medical Nutritional Therapy (MNT) in managing Metabolic-Associated Steatotic Liver Disease (MASLD), previously known as nonalcoholic fatty liver disease. It aims to examine the effectiveness of specific nutritional strategies in preventing and treating this obesity-linked liver disease.

Recent findings: Emerging evidence underscores the benefits of the Mediterranean diet, low-carbohydrate diets, and intermittent fasting in reducing liver fat, improving insulin sensitivity, and mitigating inflammation. Supplementing with vitamin E, omega-3 fatty acids, and silymarin can potentially reduce liver fibrosis and promote liver health. MNT is a key intervention for MASLD management, emphasizing dietary patterns, caloric restriction, and nutraceutical supplementation. Integrating these strategies with lifestyle modifications, including regular physical activity, offers a comprehensive approach to improving metabolic and liver outcomes in patients with MASLD. Further research is needed to refine and personalize these therapeutic interventions.

Keywords: Liver fibrosis; Medical Nutritional Therapy (MNT); Mediterranean diet; Metabolic-Associated Steatotic Liver Disease (MASLD); Nutraceutical supplementation; Obesity.

Fig. 1

Selective insulin resistance and the impact of hyperinsulinemia on hepatic lipogenesis and gluconeogenesis. Chronic hyperinsulinemia is a hallmark of insulin resistance, which is selective rather than uniform. While certain insulin signaling pathways are impaired, others remain sensitive and become overstimulated due to elevated insulin levels. In the liver, pathways involved in gluconeogenesis and glycogen synthesis become resistant to insulin, whereas the lipogenic pathway remains insulin-sensitive. This selective sensitivity leads to overstimulation of lipogenesis, resulting in hepatic fat accumulation

Fig. 2

Main lifestyle interventions and nutritional goals for the management of MASLD. The solid lines in the boxes represent evidence from studies specifically conducted on patients diagnosed with MASLD. The dashed lines indicate interventions that have been proposed or may be beneficial in managing MASLD, but for which specific studies on this patient group are lacking. The half-dashed, half-continuous box represents evidence that requires further confirmation. Abbreviations: GFD, gluten-free diet; VLEKT, very low-energy ketogenic therapy; MD, Mediterranean Diet; IF, intermittent fasting; VegD, vegetarian diet; MNT, medical nutrition therapy; Vit D-E-C, Vitamins D, E, and C; CGA, chlorogenic acid; Cur, curcumin; RSV, resveratrol; HIIT, high-intensity interval training; INF, inflammation; OxS, oxidative stress; MASLD, metabolic-associated steatotic liver disease