Comparative efficacy of different diet modalities on metabolic profiles and liver functions in metabolic...

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a global public health challenge that is primarily managed through lifestyle interventions, particularly diet. This network meta-analysis aimed to thoroughly evaluate the effectiveness of four different dietary patterns: Mediterranean diet (MD), intermittent fasting (IF), Dietary Approaches to Stop Hypertension (DASH), and low-fat diet (LF) in improving liver function and metabolic profiles in adults diagnosed with MAFLD.

In accordance with the PRISMA guidelines, we conducted a search in PubMed, Embase, Web of Science, the Cochrane Library, ClinicalTrials.gov, and WHO-ICTRP for randomized controlled trials (RCTs) up to Oct. 19, 2025, and registered the study on PROSPERO (CRD42024609524). The Cochrane Risk of Bias Tool 2.0 was used to evaluate study quality, and the surface under the cumulative ranking curve (SUCRA) was used to rank the intervention effects.

IF emerged as the most effective intervention for weight loss (WMD = -1.96 kg, 95% CI -3.01,-0.92) and reducing waist circumference (WMD = -1.73 cm, 95% CI -2.89,-0.57). Sensitivity analysis indicated that intensive IF regimens might drive stronger improvements than time-restricted feeding. The MD ranked highest for improving hepatic pathology, showing statistically significant reductions in intrahepatic lipid (IHL) (WMD = -1.68%, 95% CI -3.21, -0.16), and triglycerides (WMD = -22.54 mg/dL, 95% CI -42.79, -2.29).

IF and MD demonstrate distinct therapeutic profiles for MAFLD. IF serves as a robust strategy for weight management, particularly with more intensive regimens. Conversely, the MD demonstrates potential as a favorable strategy for targeting hepatic steatosis and lipid metabolism disorders. Therefore, clinicians are advised to adopt a personalized strategy, tailoring dietary prescriptions to the patient's primary metabolic characteristics, pending validation from high-quality, long-term RCTs.