Comparative efficacy of dietary patterns on glycemic and liver enzymes in metabolic dysfunction-associated steatotic liver disease: a network meta-analysis
In brief
DASH eating plan lowers insulin resistance by 0.6 units and reduces AST by about 5 U/L
In a network meta-analysis of 25 randomized trials, the DASH diet produced the greatest improvement in HOMA-IR (-0.60) and lowered AST (-5 U/L) compared with placebo. Mediterranean-style diets also lowered ALT, while a low-glycemic-index Mediterranean diet modestly reduced A1C but showed mixed effects on insulin resistance. These findings support dietary therapy for MASLD, though optimal diet choice remains unsettled.
- Journal
- Nutrition & metabolism (Q1)
- Published
- 13 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Vali Musazadeh, Amir Hossein Faghfouri, Mehrnaz Morvaridi, Mostafa Shahraki Jazinaki, Mahsa Mahmoudinezhad, Sanaz Barazandeh, et al.
- PMID
- 42443970
- DOI
- 10.1186/s12986-026-01161-w
Why clinicians should know about it
- Picked for Pharmacology (medical) (top studies of the week, 19 July 2026).
Abstract
BACKGROUND: Insulin resistance and hepatic dysfunction are strongly associated with metabolic dysfunction-associated steatotic liver disease (MASLD). Non-pharmacological approaches, particularly dietary interventions, have demonstrated considerable potential for mitigating these conditions. OBJECTIVES: In this network meta-analysis (NMA), we compared the relative efficacy of different dietary patterns on glycemic regulation and hepatic enzyme profiles. METHODS: A comprehensive systematic search of PubMed, Scopus, Web of Science, Cochrane, and Google Scholar was conducted from inception to March 2025. The NMA was carried out based on both direct and indirect comparisons using random-effects models. RESULTS: Pooled analysis on 25 RCTs showed that DASH diet was more effective in reducing HOMA-IR (MD = -0.60; 95% CI: -1.14, -0.05; P-scores = 0.76; p = 0.03), AST (MD = -4.99; 95% CI: -8.76, -1.21; P-scores = 0.23; p = 0.009), compared to placebo. Low-Glycemic-Index Mediterranean Diet (LGIMD) approach led to a statistically significant but not clinically meaningful decrease in A1C levels compared to the placebo (MD = -0.01%; 95% CI: -0.01, -0.005; P-scores = 0.42; p < 0.001). The Mediterranean diet (MD) significantly reduced ALT levels compared with placebo (MD = -10.21; 95% CI: -20.22 to -0.20; p = 0.04; P-score = 0.70). CONCLUSION: The present NMA indicates that dietary interventions, including the Mediterranean diet, DASH, and certain low-glycemic approaches, are effective strategies for the management of MASLD. However, a LGIMD has shown mixed glycemic effects (reduction in A1c but increase in HOMA-IR), which warrant careful interpretation and further investigation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.