Background/Objectives: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is the most common liver disease worldwide, affecting 38% of the adult population globally. Methods: We examined the impact of the Mediterranean Diet and Ultra Processed Food (UPF) intake on the risk of prevalent MASLD in older adults. Results: Our major findings include that increased adherence to a Mediterranean Dietary pattern was associated with a decreased risk of MASLD. Additionally, we found that high UPF intake was associated with an increased risk of MASLD. Furthermore, our study found that even with a high UPF intake, the risk of MASLD decreased if the individual also had a higher Mediterranean Diet intake compared to a lower Mediterranean Diet intake. Conclusions: These results are of particular importance in older people, given the known links between MASLD, metabolic comorbidities and frailty. Public health messaging should focus on promoting Mediterranean dietary habits, and ways to help older people achieve this given the social and economic barriers they may face.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, with an estimated global prevalence of 38% in adults. MASLD confers a significant increase in morbidity and mortality due to its association with cardiovascular disease and progressive liver disease, including cirrhosis and hepatocellular carcinoma. Current treatment paradigms for MASLD are centred around lifestyle modification and weight loss, with a need for pharmacotherapeutic options. Given the strong relationship between MASLD and cardiovascular disease, there is an interest in evaluating the efficacy and safety of cardiovascular medications such as statins in liver disease. Statins are the most commonly prescribed lipid-lowering medication in the world, with an established role in reducing cardiovascular morbidity and mortality. Statins are currently under-prescribed in the MASLD patient population, yet there is growing interest in determining whether statins could be utilised to treat MASLD itself. This comprehensive review aims to explore the evidence regarding the use of statin therapy for conventional, lipid-lowering indications in patients with MASLD and its potential benefits for the treatment of MASLD and its complications.