The role of dietary modification in the prevention and management of metabolic dysfunction-associated fatty liver disease: An international multidisciplinary expert consensus

Zeng XF 1 , Varady KA 2 , Wang XD 3 , Targher G 4 , Byrne CD 5 , Tayyem R 6 Show all authors , Latella G 7 , Bergheim I 8 , Valenzuela R 9 , George J 10 , Newberry C 11 , Zheng JS 12 , George ES 13 , Spearman CW 14 , Kontogianni MD 15 , Ristic-Medic D 16 , Peres WAF 17 , Depboylu GY 18 , Yang W 19 , Chen X 20 , Rosqvist F 21 , Mantzoros CS 22 , Valenti L 23 , Yki-Järvinen H 24 , Mosca A 25 , Sookoian S 26 , Misra A 27 , Yilmaz Y 28 , Kim W 29 , Fouad Y 30 , Sebastiani G 31 , Wong VW 32 , Åberg F 33 , Wong YJ 34 , Zhang P 35 , Bermúdez-Silva FJ 36 , Ni Y 37 , Lupsor-Platon M 38 , Chan WK 39 , Méndez-Sánchez N 40 , de Knegt RJ 41 , Alam S 42 , Treeprasertsuk S 43 , Wang L 44 , Du M 45 , Zhang T 46 , Yu ML 47 , Zhang H 48 , Qi X 49 , Liu X 50 , Pinyopornpanish K 51 , Fan YC 52 , Niu K 53 , Jimenez-Chillaron JC 54 , Zheng MH 55

Affiliations 

  • 1 Department of Clinical Nutrition, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  • 2 Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
  • 3 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
  • 4 Department of Medicine, University of Verona, Verona, Italy; Metabolic Diseases Research Unit, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Italy
  • 5 Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK
  • 6 Department of Human Nutrition, College of Health Science, Qatar University, Doha, Qatar
  • 7 Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
  • 8 Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
  • 9 Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
  • 10 Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
  • 11 Division of Gastroenterology, Weill Cornell Medical Center, New York, NY, USA
  • 12 Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, China; School of Medicine, School of Life Sciences, Westlake University, Hangzhou, China
  • 13 Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
  • 14 Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  • 15 Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University of Athens, Athens, Greece
  • 16 Group for Nutritional Biochemistry and Dietology, Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
  • 17 Department of Nutrition and Dietetics, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
  • 18 Izmir Katip Celebi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, İzmir, Türkiye
  • 19 Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, China
  • 20 Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
  • 21 Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden, and Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
  • 22 Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
  • 23 Precision Medicine-Biological Resource Center, Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
  • 24 Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
  • 25 Hepatology and Liver Transplant Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
  • 26 Clinical and Molecular Hepatology, Translational Health Research Center (CENITRES), Maimónides University, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Faculty of Health Science, Maimónides University, Buenos Aires, Argentina
  • 27 Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI), New Delhi, India
  • 28 Department of Gastroenterology, School of Medicine, Recep Tayyip Erdogan University, Rize, Türkiye
  • 29 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
  • 30 Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
  • 31 Division of Gastroenterology and Hepatology and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada; Division of Experimental Medicine, McGill University, Montreal, Canada
  • 32 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
  • 33 Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • 34 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; Duke-NUS Medical School, SingHealth, Singapore
  • 35 Department of Clinical Nutrition, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  • 36 Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain; Clinical Unit of Endocrinology and Nutrition, University Regional Hospital of Málaga, Málaga, Spain; The Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
  • 37 Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, China
  • 38 Department of Medical Imaging, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepathology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  • 39 Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 40 Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
  • 41 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
  • 42 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 43 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 44 School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
  • 45 Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
  • 46 School of Public Health, the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
  • 47 Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver, National Sun Yat-sen University, Kaohsiung, Taiwan
  • 48 Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • 49 Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
  • 50 Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China
  • 51 Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 52 Department of Hepatology, Qilu Hospital, Shandong University, Jinan, China
  • 53 School of Public Health of Tianjin University of Traditional Chinese Medicine, Tianjin, China; Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
  • 54 Institut de Recerca Sant Joan de Déu, SJD-Barcelona Children's Hospital, Endocrine Division, Esplugues, Barcelona, Spain; Department of Physiological Sciences, School of Medicine, University of Barcelona, L'Hospitalet, Barcelona, Spain
  • 55 MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China. Electronic address: zhengmh@wmu.edu.cn
Metabolism, 2024 Dec;161:156028.
PMID: 39270816 DOI: 10.1016/j.metabol.2024.156028

Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), has become the leading cause of chronic liver disease worldwide. Optimal dietary intervention strategies for MAFLD are not standardized. This study aimed to achieve consensus on prevention of MAFLD through dietary modification. A multidisciplinary panel of 55 international experts, including specialists in hepatology, gastroenterology, dietetics, endocrinology and other medical specialties from six continents collaborated in a Delphi-based consensus development process. The consensus statements covered aspects ranging from epidemiology to mechanisms, management, and dietary recommendations for MAFLD. The recommended dietary strategies emphasize adherence to a balanced diet with controlled energy intake and personalized nutritional interventions, such as calorie restriction, high-protein, or low-carbohydrate diets. Specific dietary advice encouraged increasing the consumption of whole grains, plant-based proteins, fish, seafood, low-fat or fat-free dairy products, liquid plant oils, and deeply colored fruits and vegetables. Concurrently, it advised reducing the intake of red and processed meats, saturated and trans fats, ultra-processed foods, added sugars, and alcohol. Additionally, maintaining the Mediterranean or DASH diet, minimizing sedentary behavior, and engaging in regular physical activity are recommended. These consensus statements lay the foundation for customized dietary guidelines and proposing avenues for further research on nutrition and MAFLD.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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