Dietary interventions in metabolic dysfunction-associated steatotic liver disease: current evidence, research priorities, and clinical translation.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to excess adiposity, insulin resistance, and adverse dietary patterns. Dietary management is a potentially disease-modifying component of care, but no single standardized "MASLD diet" applies to all patients. This narrative review evaluates energy restriction, Mediterranean-style eating, low-carbohydrate, ketogenic, dietary approaches to stop hypertension (DASH), intermittent fasting, vegetarian, and plant-based approaches, together with practical food-based recommendations. The strongest evidence supports improved dietary quality and, in patients with excess body weight, a sustainable energy deficit that produces clinically meaningful weight loss. Mediterranean-style eating remains the best-supported named pattern, although evidence is stronger for liver fat and cardiometabolic outcomes than for histological or clinical liver outcomes. Management should prioritize minimally processed, predominantly plant-based, fiber-rich foods and unsaturated fats while limiting sugar-sweetened beverages, refined carbohydrates, ultra-processed foods, red and processed meat, and alcohol. Normal-weight MASLD, cirrhosis, and incretin-associated weight loss require individualized goals emphasizing metabolic control, nutritional adequacy, and muscle preservation.