Effect of a Low-Calorie Dietary Intervention on Liver Health and Body Weight in Adults with Metabolic-Dysfunction Associated Steatotic Liver Disease (MASLD) and Overweight/Obesity: A Systematic Review and Meta-Analysis

Abstract

Introduction: Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD) is a common cause of chronic liver disease. This review assessed the efficacy of a Low-Calorie Diet (LCD) on liver health and body weight in people living with MASLD and obesity. Methods: The study was registered with PROSPERO (CRD42021296501), and a literature search was conducted using multiple databases. The key inclusion criteria were randomised controlled trials or cohort studies, obesity/overweight and MASLD. Two authors screened abstracts, reviewed full texts and performed data extraction and quality assessment. The primary outcome was the change in the serum ALT, and secondary outcomes included the changes in the serum AST, intrahepatic lipid content (IHL), quantified non-invasively via MRI/MRS, and body weight. Results: Fifteen studies were included. The LCD reduced body weight by 9.1 kg versus the control (95%CI: −12.4, −5.8) but not serum ALT (−5.9 IU/L, −13.9, 2.0). Total Dietary Replacement (TDR) reduced IHL by −9.1% vs. the control (−15.6%, −2.6%). The Mediterranean-LCD for ≥12 months reduced ALT (−4.1 IU/L, −7.6, −0.5) and for 24 months reduced liver stiffness versus other LCDs. The Green-Mediterranean-LCD reduced IHL, independent of body weight. Limited studies assessed those of Black or Asian ethnicity, and there was heterogeneity in the methods assessing the liver fat content and fibrosis. Conclusions: In people with MASLD and obesity, an LCD intervention reduces IHL and body weight. Trials should focus on the recruitment of Black and Asian ethnicity participants.

Multipanel Approach including miRNAs, Inflammatory Markers, and Depressive Symptoms for Metabolic Dysfunction-Associated Steatotic Liver Disease Diagnosis during 2-Year Nutritional Intervention

“…Low-calorie diets (LCD) may reduce body weight and liver fat content in both MASLD and obese subjects, improving liver enzyme levels. Furthermore, Mediterranean-style LCDs, especially green-Mediterranean variants, may independently lower intrahepatic lipid content (IHL) and ALT levels compared to other LCDs [ 88 ]. Further insights from dietary intervention trials involving MASLD subjects are crucial to better understanding the dynamics of the contributing factors over time and their potential to differentiate the disease, thus serving as a personalized precision nutrition tool.…”

Effects of a Two-Year Lifestyle Intervention on Intrahepatic Fat Reduction and Renal Health: Mitigation of Inflammation and Oxidative Stress, a Randomized Trial

“…A recent systematic review and meta-analysis highlighted the Mediterranean lowcalorie diet as a favourable dietary approach for individuals with MAFLD and obesity [59]. This dietary pattern was associated with improved liver enzyme profiles in MAFLD patients.…”

“…This dietary pattern was associated with improved liver enzyme profiles in MAFLD patients. Additionally, it was suggested that it may contribute to a reduction in IFC and overall liver health [59]. However, despite both current responders and non-responders to IFC improvement exhibiting higher adherence to the MedDiet and lower calorie consumption, only the responder group demonstrated a significant increase in VO 2 max after the 2-year intervention period.…”