Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) involves insulin resistance, altered iron homeostasis, and oxidative stress. We explored changes in hepatic steatosis and cardiometabolic parameters following targeted micronutritional supplementation. Methods: In this prospective, single-center, open-label, single-arm pilot study, 15 adults with ultrasound-confirmed moderate-to-severe hepatic steatosis received two standardized micronutrient formulations for four months, alongside previously established dietary recommendations. No new structured weight-loss program was introduced. The pre-specified primary efficacy target was a ≥10% reduction in Fatty Liver Index (FLI). Secondary outcomes included ultrasound steatosis severity, metabolic and biochemical parameters, quality of life, and safety. Results: The primary efficacy target was not achieved. Mean FLI decreased by 2.55 points (59.18 ± 26.67 to 56.63 ± 27.48), corresponding to a 4.3% relative reduction (p = 0.256). Exploratory analyses showed a shift towards lower ultrasound-defined steatosis grades (nominal p = 0.010), with severe steatosis decreasing from 46.7% to 6.7%. BMI remained unchanged, while waist circumference decreased by 0.89 cm (p = 0.046). Fasting glucose (p = 0.033), insulin (p = 0.025), homocysteine (−23%; p = 0.001), and ferritin (p = 0.007) decreased, while transferrin saturation increased (p = 0.005). No serious adverse events occurred. Conclusions: Although the primary endpoint was not met, micronutritional support was associated with exploratory improvements in ultrasound-defined steatosis and selected cardiometabolic biomarkers. Larger controlled trials are warranted.