Two-Year Mediterranean Diet Intervention Improves Hepatic Health in MASLD Patients

<b><i>Background:</i></b> Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is one of the leading causes of chronic liver disease, affecting 30% of the global adult population and continuing to rise. <b><i>Objective:</i></b> We aimed to assess the effect of a two-year follow-up Mediterranean diet intervention on parameters of liver health in MASLD patients. <b><i>Methods:</i></b> Sixty-two people between 40 and 60 years of age, all diagnosed with MASLD, were enrolled in the two-year clinical trial, who were randomly assigned to one of three interventions following the Mediterranean diet pattern and the promotion of physical activity. After the intervention, the participants were categorized into two groups according to their progress in adhering to the Mediterranean diet (MedDiet), which was assessed at four follow-up time points, conducted at the start of this study and after 6, 12, and 24 months of intervention. A multivariate general linear model adjusted for age, sex, and intervention (diet and physical activity) was used. Bonferroni's post hoc test identified differences between groups and sessions within the same group. <b><i>Results:</i></b> Participants in the highly adherent group showed significantly stronger improvement in anthropometric measures, lipid profile, and liver enzyme levels during the follow-up period, along with a reduction in the Dietary Inflammatory Index, intrahepatic fat content, the fatty liver index, and plasma cytokeratin-18 levels compared to baseline. The progress observed in several parameters at 12 months came to a standstill, likely because of the COVID-19 pandemic at that time. At 24 months, following the COVID-19 pandemic, these parameters improved as a result of better adherence to the Mediterranean diet. <b><i>Conclusions:</i></b> Greater adherence to the Mediterranean diet, along with increased physical activity, significantly enhances liver health markers in individuals with MASLD. These findings support the Mediterranean lifestyle as an effective non-pharmacological strategy to improve liver health and prevent liver-related complications in MASLD patients, potentially reducing the future public health burden.