Personalized dietary management in metabolic associated steatotic liver disease

Diet is a fundamental pillar in the management of metabolic-associated steatotic liver disease (MASLD), as it improves clinical and metabolic status. Weight loss of 7-10% has been shown to enhance steatosis and liver biochemistry, while a reduction > 10% can reverse mild to moderate fibrosis. The Mediterranean diet is the most studied and recommended due to its richness in monounsaturated fats, polyphenols, and omega-3 fatty acids, which contribute to reducing liver inflammation and improving lipid and glucose metabolism. Other approaches, such as the DASH (Dietary Approaches to Stop Hypertension) diet, low-carbohydrate or low-fat diets, ketogenic diets, time-restricted feeding, and plant-based diets, also show benefits, albeit with less evidence and long-term follow-up. In regional contexts, such as Mexico, traditional and localized diets based on local foods and vegetables can be as effective as the Mediterranean diet in improving hepatic steatosis. It is important to remember that personalized nutritional education and the use of mobile technologies promote long-term adherence and self-care, which are key factors for therapeutic success. In conclusion, individualizing the diet, tailored to the characteristics and comorbidities of the patient, is essential for optimizing the treatment of MASLD.