A network meta-analysis of the clinical efficacy of different dietary patterns in the treatment of adult metabolic dysfunction-associated steatotic liver diseases

<h2>Summary</h2><h3>Background</h3> Deipite considerable literature supports the benefits of dietary interventions for Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), the most effective dietary approach remains unclear. We conducted a systematic review and network meta-analysis (NMA) to assess the relative efficacy of different dietary approaches on improving liver function, Controlled Attenuation Parameter (CAP), body weight and Body Mass Index (BMI) in adults with MASLD. <h3>Methods</h3> We searched PubMed, the Cochrane Library, Embase and Web of Science up to March 2025 for controlled trials of different dietary approaches in adult MASLD patients. Primary outcomes were liver function and CAP, with secondary outcomes being body weight and BMI. For each outcome, the pooled effect of each intervention compared with others was determined. Mean differences (MDs) and 95% confidence intervals (95%CI) were calculated. The surface under the cumulative ranking curve (SUCRA) was used to rank dietary approaches. <h3>Results</h3> Overall, 30 trials were included, comparing five macronutrient approaches (Moderate macronutrients, Low carbohydrate (LCD), Low fat, Dietary advice, and Usual diet) and 12 dietary interventions [Atkins, DASH, Weight Watchers, Volumetrics, Low sugar diet, Low GI diet (LGID), Calorie Restriction (CR), Portfolio, Mediterranean, Low fat diet (LFD), Dietary advice, and Usual diet], involving 2051 patients. Regarding macronutrients, Moderate macronutrients demonstrated the most effective improvement in liver function (SUCRA: 76.35%); LCD proved most effective for improving both CAP (SUCRA: 91.5%) and body weight (SUCRA: 94.35%). Among dietary patterns, Portfolio was most effective for improving liver function (SUCRA: 85%), while LGID was most effective for improving CAP (SUCRA: 74.9%); The Atkins diet demonstrated the best overall improvement in body mass and BMI (SUCRA: 76.55%). <h3>Conclusions</h3> Moderate macronutrients and Portfolio diets were most effective for improving liver function, while LGID was the most effective approach for reducing CAP. The LCD and Atkins diets were considered the most effective dietary approaches for comprehensively improving body mass and BMI.