Exploring the Metabolic Benefits of Mediterranean, Fasting, and DASH Diets in Managing MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), affects nearly one-third of the global population and is linked to obesity, diabetes, and other cardiometabolic conditions. Characterized by fat accumulation in the liver, MASLD can progress to inflammation, fibrosis, and even liver cancer if unmanaged. Its rising prevalence makes effective management strategies critically important.

Lifestyle and dietary modifications remain the primary approach to managing MASLD, alongside emerging pharmacotherapies. A recent systematic review highlighted promising evidence supporting specific dietary patterns for improving liver health and overall metabolic function.

The Mediterranean diet (MED), originating from the cuisine around the Mediterranean Sea, is rich in fruits, vegetables, whole grains, nuts, and olive oil, with moderate consumption of fish and poultry, and limited red meat and processed foods. Studies reveal that adhering to the MED significantly reduces body weight, BMI, and waist circumference, while also improving glycemic control and lowering inflammatory markers. Importantly, early data suggest that the Mediterranean diet may positively influence liver enzymes and reduce the severity of MASLD.

Intermittent fasting (IF), particularly alternate-day fasting and time-restricted feeding (like the 16/8 method), also shows substantial benefits. These fasting protocols help improve anthropometric measures, reduce fasting glucose, triglycerides, and LDL cholesterol, and decrease systemic inflammation. The metabolic switch during fasting from glucose to ketones plays a role in reducing fat deposition in the liver, thereby supporting liver health.

Beyond these, the DASH diet, primarily designed to control blood pressure, has demonstrated benefits in decreasing weight and improving metabolic parameters, including fasting glucose, insulin levels, and triglycerides. Similarly, the lacto-ovo-vegetarian diet has shown potential in reducing liver enzymes and fibrosis biomarkers by promoting nutrient-dense, minimally processed foods.

This review underscores the potential of various dietary interventions to manage MASLD effectively. While the Mediterranean diet and intermittent fasting are especially promising, other dietary patterns like DASH and vegetarian diets also contribute to better liver and metabolic health.

Despite encouraging findings, further long-term research is necessary to confirm these benefits and clarify the mechanisms involved, ensuring safe and personalized dietary strategies for those affected by MASLD.