Researchers of this two-year randomized trial tested whether a hypocaloric Mediterranean-style dietary program—with or without structured physical activity—could reduce intrahepatic fat content (IFC) in adults (40-60 years) with obesity, metabolic syndrome, and MRI-confirmed metabolic-associated fatty liver disease (MAFLD). Researchers also evaluated whether changes in liver fat relate to kidney health and systemic oxidative/inflammatory status. Sixty-seven participants were randomized to one of three arms (conventional energy-restricted diet; Mediterranean diet with high meal frequency; Mediterranean diet plus interval training), all with an approximately 25% to 30% calorie reduction. A biomarker subgroup (n=40) was analyzed by IFC response after 24 months (responders vs non-responders).

Irrespective of assignment, participants who reduced IFC showed lower liver fat and stable liver stiffness, greater fitness, weight/body mass index loss, improved lipids, reduced liver enzymes, and lower ferritin and uric acid. They also had less oxidative stress and inflammation and better kidney indices. Non-responders tended toward higher liver stiffness, slightly higher diastolic blood pressure, compensatory rises in erythrocyte antioxidant enzymes, increased urinary cystatin C/creatinine, and worsening creatinine/Modification of Diet in Renal Disease. Overall, achieving liver-fat reduction with a Mediterranean-based lifestyle program was linked to favorable hepatic, cardiometabolic, inflammatory, and renal profiles. These results support a clinical connection between MAFLD and chronic kidney disease and the importance of kidney monitoring in MAFLD care.

Reference: Quetglas-Llabrés MM, Monserrat-Mesquida M, Bouzas C, et al. Effects of a Two-Year Lifestyle Intervention on Intrahepatic Fat Reduction and Renal Health: Mitigation of Inflammation and Oxidative Stress, a Randomized Trial. Antioxidants (Basel). 2024;13(7):754. doi: 10.3390/antiox13070754.

A diagnosis of metabolic-associated steatotic liver disease, or metabolic dysfunction–associated steatohepatitis, can feel overwhelming, but small, realistic changes add up. Researchers encourage patients to personalize goals and start where they are. For instance, adding about 2,500 steps per day is associated with an approximately 20% lower risk of disease progression. A Mediterranean-style eating pattern (fruits, vegetables, whole grains, lean proteins) with limited added sugars and processed foods is recommended, and up to three cups of black coffee daily may help. Alcohol should be used cautiously and avoided with advanced scarring or when fibrosis stage is uncertain. Dr. Jonathan Stine emphasizes that individualized plans tend to be more sustainable.

Sustainable habits matter: Patients should target 150 minutes per week of moderate activity, include simple resistance exercises, and split sessions into 10-minute bouts as needed. Trackers and apps can support gradual change. Starting with at least 500 steps per day builds momentum, and a 10% fitness improvement is associated with an approximately 15% lower mortality. Consistency beats perfection. Occasional indulgences can be followed by a reset the next day. Additional education and peer support can improve adherence over time.

Reference: Betel M, Stine J. Practical Lifestyle Tips for MASLD and MASH Patients. Fatty Liver Alliance. Published January 26, 2025. Accessed October 10, 2025. https://fattyliver.ca/blog/f/practical-lifestyle-tips-for-masld-and-mash-patients?blogcategory=Liver+Insights+2+for+Patients

The American Diabetes Association’s 2025 consensus report reframes fatty liver disease as metabolic-associated steatotic liver disease (MASLD)/metabolic dysfunction–associated steatohepatitis (MASH) to emphasize metabolic drivers and reduce stigma. Among adults with type 2 diabetes, ≥70% have MASLD, about 50% have MASH, and about 1 in 5 already have advanced fibrosis—levels that markedly raise risks for cirrhosis, hepatocellular carcinoma, cardiovascular disease, extrahepatic cancers, poorer quality of life, and transplant.

The guidance recommends early, routine risk stratification using a two-tier, noninvasive pathway, electronic medical record-embedded decision support, and long-term monitoring. Management centers around lifestyle therapy—Mediterranean-style nutrition, regular physical activity, and weight loss. It also includes cardiometabolic optimization that prioritizes dual-benefit agents such as GLP-1 receptor agonists, SGLT2 inhibitors, and pioglitazone when appropriate. Targeted liver pharmacotherapy is led by resmetirom, with additional supportive data for semaglutide. Care should be delivered by interprofessional teams, with special considerations in cirrhosis. With systematic screening, timely treatment, and coordinated care, progression to cirrhosis in diabetes can be prevented and outcomes meaningfully improved.

Reference: Cusi K, Abdelmalek MF, Apovian CM, et al. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in People With Diabetes: The Need for Screening and Early Intervention. A Consensus Report of the American Diabetes Association. Diabetes Care. 2025;48(7):1057-1082. doi: 10.2337/dci24-0094.