Nutrition in MASLD: Frontline Gastroenterology | 2026

Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the leading cause of chronic liver disease worldwide and closely parallels the epidemics of obesity and type 2 diabetes. Lifestyle modification remains the first-line, evidence-based treatment, but in real practice there is often a major gap between guideline advice and what patients are actually able to follow. This review focuses on nutrition as the central modifiable factor in MASLD care, while also recognizing the importance of physical activity, sleep, culture, affordability, and food access.

Problem Statement

The major challenge in MASLD is not only knowing that diet matters, but translating broad recommendations into realistic, culturally sensitive, affordable, and sustainable nutrition advice for individual patients in busy clinical practice.

Summary

This review makes a strong case that nutrition should be at the centre of MASLD management. The main dietary message is to reduce ultra-processed foods, sugar-sweetened beverages, commercially produced fructose, saturated fats, and excess calories, while encouraging whole foods, vegetables, fruits, legumes, wholegrains, nuts, seeds, olive or rapeseed oil, and oily fish. The Mediterranean diet remains the most evidence-supported pattern because it improves liver fat and cardiometabolic health, sometimes even without significant weight loss. However, the authors rightly stress that the best diet is the one a patient can actually follow long term, so dietary advice must be personalized and culturally adapted.

The review also explains the role of macronutrients and micronutrients. Fructose and saturated fat promote steatosis, while fibre, unsaturated fats, and adequate protein intake are protective. Micronutrients such as vitamin E, vitamin D, vitamin C, zinc, and polyphenols may influence liver health, although routine supplementation is not broadly recommended unless there is deficiency or a specific indication. Alcohol avoidance is emphasized, especially in more advanced disease.

A particularly valuable part of this paper is its practical approach. It recognizes food insecurity, cost, and social context as real barriers. It gives adaptable Mediterranean-style advice for South and Southeast Asian, African, and lower-income populations, and even provides simple clinic checklists and sample menus. The overall message is clear: MASLD nutrition care should move from generic advice to compassionate, individualized, practical counselling that patients can sustain.