Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health concern, linked with immune-metabolic dysfunction. While lifestyle and dietary modifications remain the cornerstone of MASLD management, the optimal dietary approach remains uncertain. Objectives: This systematic review aims to investigate the impact of model dietary patterns on metabolic outcomes in patients with MASLD and evaluate their effects in individuals with coexisting metabolic conditions, such as obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). Methods: To conduct the review, PubMed, Scopus, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov databases were searched for Randomized Controlled Trials (RCTs) on the adult population, published between January 2019 and September 2024, following PRISMA principles. The quality of the included RCTs was assessed qualitatively based on study characteristics. Results: The main findings of this review demonstrated that the use of interventions with dietary model based on Mediterranean diet (MED) and intermittent fasting (IF) approaches, such as alternative-day fasting (ADF) and time-restricted feeding regimens (TRF) may have potential in reducing body weight, BMI, and waist circumference, with additional benefits of improving glycemic control and reducing inflammation. The effects on hepatic functions, although limited, may be linked with reduced enzyme activity and liver stiffness. Additionally, the use of lacto-ovo-vegetarian diet (LOV-D) and the Dietary Approaches to Stop Hypertension (DASH) diet may offer additional health benefits, including blood pressure management. Conclusions: This review suggests that MED and IF-based strategies may reduce BW, improve glycemic control, and lower inflammation, with potential benefits for hepatic function. Further long-term studies are needed to confirm these effects and underlying mechanisms, which will allow for the optimization of protocols and ensure their safety in MASLD.

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH) are increasingly prevalent in patients undergoing bariatric surgery (BS). Understanding their impact on weight loss outcomes after surgery and highlighting the results of surgical techniques such as Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) in relation to the presence of MASH are essential for improving patient management and predicting long-term success. Methods: A systematic review and meta-analysis were conducted. We searched the PubMed database; inclusion criteria were BS patients with liver impairment data at surgery and weight loss data at follow-up of 6 months or longer. Meta-analyses were conducted using R’s meta package, assessing heterogeneity with the I² statistic and employing subgroup analyses where necessary. Results: Out of 1126 eligible studies, 22 were included in the final systematic review. For the MASLD vs. Normal Liver (NL) comparison, no significant difference in BMI change was found at 12 months, but subgroup analysis indicated a possible publication bias (published data vs data collected). In the MASH vs. non-MASH comparison, high heterogeneity was noted at 12 months, and further stratification by surgical technique revealed that SG patients with MASH experienced lower weight loss, approaching statistical significance. Conclusions: MASLD does not significantly affect short-term weight loss outcomes post-BS, but long-term results show variability. Standardized reporting practices and complete data dissemination are essential for future research to enhance meta-analysis reliability and generalizability. Graphical

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. Some patients progress to metabolic dysfunction-associated steatohepatitis (MASH), characterized by inflammation and fibrosis. MASH diagnosis still depends on invasive liver biopsy, as accurate and validated noninvasive biomarkers are lacking. We aim to investigate the potential of sTREM2 as a noninvasive diagnostic marker for detecting early MASH. This study involved 68 Caucasian women with severe-morbid obesity undergoing bariatric surgery, during which liver biopsies and fasting blood samples were collected. Soluble TREM2 levels in plasma were measured by ELISA, while hepatic TREM2 gene expression was analyzed via qPCR. Macrophage infiltration in liver tissue was assessed through CD68 immunohistochemistry. Serum sTREM2 levels were significantly higher in patients with MASH compared to those with NL (normal liver) and SS (simple steatosis), and ROC analysis demonstrated strong diagnostic performance for identifying early MASH (AUC=0.89). sTREM2 levels increased progressively with steatosis grade, lobular inflammation, and NAS score. Similarly, hepatic TREM2 mRNA expression was significantly elevated in MASH and correlated with histological severity, including steatosis, ballooning, and inflammation. CD68+ macrophage infiltration was significantly higher in MASH, and strong correlations were observed between sTREM2, TREM2 expression, CD68+ cells, and MASLD-related biochemical and histological features. Our findings show that sTREM2 is elevated in early MASH, correlates with hepatic TREM2 expression and macrophage infiltration, and reflects key histological and biochemical features of disease progression. These results support sTREM2 as a promising non-invasive serum biomarker for identifying reversible stages of MASH.

Metabolic-associated steatohepatitis (MASH), the progressive form of metabolic-associated steatotic liver disease (MASLD), poses significant risks for liver fibrosis and cardiovascular complications. Despite extensive research, reliable biomarkers for MASH diagnosis and progression remain elusive. This study aimed to identify hepatic transcriptomic and circulating proteomic signatures specific to MASH, and to develop a machine learning-based biomarker discovery model. A systematic review of RNA-Seq and proteomic datasets was conducted, retrieving 7 hepatic transcriptomics and 3 circulating proteomics studies, encompassing 483 liver samples and 169 serum/plasma samples, respectively. Differential gene and protein expression analyses were performed, and pathways were enriched using gene set enrichment analysis. A machine learning (ML) model was developed to identify MASH-specific biomarkers, utilizing biologically significant protein ratios. Hepatic transcriptomic analysis identified 5017 differentially expressed genes (DEGs), with significant enrichment of extracellular matrix (ECM) pathways. Serum proteomics revealed six differentially expressed proteins (DEPs), including complement-related proteins. Integration of transcriptomic and proteomic data highlighted the complement cascade as a key pathway in MASH, with discordant regulation between the liver and circulation. The ML-based biomarker discovery model, utilizing protein ratios, achieved an F1 scores of 0.83 and 0.64 in the training sets and 0.67 in an external validation set. Our findings indicate ECM deregulation and complement system involvement in MASH progression. The novel ML model incorporating protein ratios offers a potential tool for MASH diagnosis. However, further refinement and validation across larger and more diverse cohorts is needed to generalize these results.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the most prevalent liver diseases, affecting up to 40% of adults and strongly associated with obesity and metabolic dysfunction. Despite the lack of approved pharmacological treatments, dietary interventions with plant-based foods, including the Mediterranean diet (MED), rich in numerous bioactive compounds may offer benefits for metabolic health and hepatic function. However, the role of individual plant foods in MASLD management remains unclear. Objectives: This review investigates the effects of specific plant-based foods, consumed as part of the MED and Dietary Approaches to Stop Hypertension (DASHs) diet, on metabolic outcomes, including hepatic function, in MASLD patients alone or in combination with comorbidities such as obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM). Methods: A systematic search was registered and conducted across nine databases to identify randomized controlled trials (RCTs) carried out in adults with MASLD and published between January 2020 and May 2025, following PRISMA guidelines. Results: Plant-based interventions including oranges, whole-grain products (WGPs), high-fiber buns (HFBs), beetroot juice (BJ), garlic, ginger, flaxseed, spirulina, rapeseed oil, sour tea, and green coffee extract (GCE) demonstrated mixed effects on metabolic and hepatic outcomes. GCE, flaxseed, and rapeseed oil improved anthropometric measures, while sour tea and ginger supported blood pressure control. WGPs, GCE, flaxseed, rapeseed oil, spirulina, ginger, and garlic were beneficial for glycemic regulation, whereas WGPs, HFBs, BJ, golden flaxseed, rapeseed oil, and garlic improved lipid profiles. Liver enzymes improved following consumption of WGPs, BJ, sour tea, flaxseed oil, and garlic, and hepatic steatosis was reduced after intake of oranges, WGPs, HFBs, BJ, flaxseed powder, rapeseed oil, and garlic powder. Conversely, a solely fruit-rich diet (FRD) had negative effects across all outcomes. Conclusions: Plant-based foods improved metabolic outcomes, with WGPs, HFBs, beetroot, oranges, sour tea, flaxseed oil, and garlic providing specific benefits for liver health. Further research is needed to validate these effects and ensure their safety in MASLD management.

Background: The rising consumption of ultra-processed foods, especially those high in added sugars, poses a growing public health concern. Although several tools exist to assess food addiction, there is a lack of validated instruments specifically designed to measure addiction-like behaviors related to sweet food intake. Objectives: This study evaluates the psychometric properties of the FitMIND Foundation Sweets Addiction Scale (FFSAS), adapted from the Yale Food Addiction Scale 2.0 (YFAS 2.0), using data from Polish adults recruited through the FitMIND Foundation. Methods: The FFSAS was evaluated by 11 expert judges on four criteria: clarity, content validity, linguistic appropriateness, and construct representativeness. Afterwards, 344 adult volunteers (mean age 40.6 ± 10.7 years, 78% female, mean body mass index (BMI) 27.86 kg/m²) completed online FFSAS and provided demographic data, BMI, and self-reported sweets consumption. Internal consistency was assessed with Cronbach’s alpha and external validity was examined through Spearman’s correlations. Moreover, we conducted Exploratory and Confirmatory Factor Analyses (EFA and CFA). Results: Content validity of the FFSAS was supported by expert validation. The scale demonstrated good overall internal consistency (α = 0.85), with specific criteria such as tolerance (α = 0.916) and withdrawal (α = 0.914) showing particularly high reliability. The FFSAS total score was moderately correlated with sweets consumption frequency (ρ = 0.39, p < 0.05) and feelings of guilt (ρ = 0.35, p < 0.05). Exploratory factor analysis (EFA) revealed a robust three-factor structure, explaining 68.6% of the variance; the individual factors (subscales) derived from this structure demonstrated excellent internal consistency (Cronbach’s α ranging from 0.951 to 0.962). Sampling adequacy was high based on Kaiser–Meyer–Olkin measure (KMO = 0.956). Confirmatory factor analysis (CFA) indicated suboptimal model fit (Comparative Fit Index (CFI) = 0.74, Tucker–Lewis Index (TLI) = 0.69, Root Mean Square Error of Approximation (RMSEA) = 0.14), with a significant chi-square test (χ² = 3761.76, p < 0.001). Conclusions: This pilot study demonstrated that the FFSAS may be a promising tool for assessing sweet food addiction in adults. Future research should focus on assessing the FFSAS’ suitability on more diverse populations in other countries for further validation.