Nutrition in MASLD: A patient focused, evidence-based clinician's guide

The prevalence and burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is very high globally, especially in socially deprived areas. This trend parallels the increasing incidence of type 2 diabetes mellitus and obesity. While MASLD is influenced by multiple factors, including genetics, metabolism and the environment, key modifiable contributors include nutrition, sedentary behaviour, physical activity and sleep quality. The widespread shift towards consumption of ultra-processed food highlights growing concerns around food insecurity and nutritional quality. This review, produced by a multinational team, focuses primarily on the role of nutrition in the prevention and management of MASLD. While physical activity remains a vital component of lifestyle modification, the central emphasis of this review is placed on dietary factors. In this study, we summarise recommendations made by international clinical practice guidelines and highlight the important role that both macronutrients and micronutrients play in liver health. We also evaluate five major dietary patterns in the context of MASLD, outlining the benefits and limitations of each to best support evidence-based patient counselling. We emphasise the importance of personalised and culturally sensitive nutritional advice. Practical tools are provided, including a nutrient-focused summary of beneficial foods and culturally adaptable Mediterranean diet modifications suitable for South and Southeast Asian, African and socioeconomically disadvantaged populations. A sample menu is included to support implementation of the tools in diverse clinical settings.