Nutraceutical Strategies for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Path to Liver Health

Abstract

MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) is a growing global concern. Nutraceuticals offer an appealing approach by targeting key mechanisms, such as oxidative stress, inflammation, lipid metabolism, and insulin resistance. This narrative review examines the role of various nutraceuticals in MASLD treatment, including silymarin, vitamin E, omega-3, curcumin, berberine, and coenzyme Q10. Some of them show promising biochemical and metabolic changes, while others produce conflicting results due to relevant studies' design and endpoints. To bridge the gap between research and reality, we summarize the data, create an interpretation heatmap, and develop a practical supplement guide. Regardless of their potential, nutraceuticals should be viewed as add-ons to lifestyle interventions rather than standalone treatments. Future research should focus on well-designed, long-term studies to prove efficacy, dosing, and combination strategies for personalized MASLD management.

Keywords: MASH; MASLD; NAFLD; insulin resistance; metabolic dysfunction; nutraceuticals; oxidative stress.

Figure 1

The evidence levels for nutraceutical effectiveness in MASLD management. This heatmap visualizes the strength of evidence supporting different supplements for various clinical outcomes in the management of MASLD. The Y-axis lists the evaluated supplements, while the X-axis presents key clinical outcomes, including steatosis, fibrosis, AST/ALT levels, HOMA-IR, BMI reduction, lipid profile improvement, and modulation of inflammatory markers. Color coding represents the quality and consistency of evidence: Green indicates strong clinical evidence from randomized controlled trials and meta-analyses; yellow indicates limited or inconsistent clinical evidence; and red represents weak, inconsistent, or primarily preclinical evidence. MASLD, Metabolic Dysfunction-Associated Steatotic Liver Disease; AST, Aspartate transaminase; ALT, Alanine transaminase; HOMA-IR, homeostasis model assessment-estimated insulin resistance; BMI, body mass index.