Related Experiment Video
Updated: May 22, 2026

In Vitro Modeling of Fat Deposition in Metabolic Dysfunction-Associated Steatotic Liver Disease
Published on: July 19, 2024
The effects of ketogenic diet and calorie-restricted diet on metabolic dysfunction-associated steatotic liver
Wei-Jie Sun1, Lin-Li Xing1, Su-Fen Zhao1
1Office of Nutrition and Diet, Affiliated Hangzhou Xixi Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
Objective:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent condition with limited established dietary therapies. Lifestyle modifications, particularly dietary adjustments, represent the primary therapeutic approach for MASLD. This study investigated the effects of ketogenic diet (KD) and calorie-restricted diet (CRD) on hepatic fat accumulation and metabolic parameters in MASLD patients.
Methods:
This retrospective cohort study analyzed 102 MASLD patients completing 12-week nutritional management (KD or CRD). FibroTouch, anthropometric, body composition, and laboratory parameters were assessed at baseline and week 12.
Results:
After 12 weeks, the KD group achieved a significantly greater reduction in CAP (ΔCAP) compared to the CRD group (median ΔCAP: 62.0 dB/m (IQR: 48.0-78.5) vs. 36.0 dB/m (IQR: 26.0-52.0); p < 0.001, Cohen's d = 0.93). A clinically meaningful reduction (≥40 dB/m) was achieved in 43 patients (84.3%) in the KD group, compared with 23 patients (45.1%) in the CRD group (p < 0.001). The proportion of patients with moderate-to-severe steatosis decreased more significantly in the KD group (68.6% vs. 39.2%, p < 0.05). No significant between-group difference was observed in liver stiffness measurement (LSM), although both groups showed significant within-group improvements. The KD group demonstrated significantly greater improvements in BMI, fat mass, body fat percentage, visceral fat grade, and waist-to-height ratio (all p < 0.05, Cohen's d range: 0.44-1.07). However, the KD group also exhibited a significantly greater reduction in muscle mass compared to the CRD group (median Δ: 3.0 kg vs. 1.8 kg; p < 0.001, Cohen's d = 0.59). Changes in body weight and waist-to-hip ratio were similar between groups. Among blood biomarkers, only fasting insulin showed a significantly greater reduction in the KD group (median Δ: 6.4 μIU/mL (IQR: 3.4-13.1) vs. 4.7 μIU/mL (IQR: 1.4-9.2); p < 0.05, Cohen's d = 0.37). No significant between-group differences were observed in liver enzymes, lipid profile, fasting glucose, HOMA-IR, or inflammatory markers (all p > 0.05).
Conclusion:
KD significantly reduced hepatic steatosis and fasting insulin versus CRD, with comparable weight loss but greater muscle loss warranting caution. These findings support KD as a promising MASLD intervention, requiring confirmation in larger trials.
Related Concept Videos
Overview of Lipid Metabolism
Lipolysis: The Breakdown of Lipids:
Lipolysis is the process of breaking down lipids, particularly triglycerides, into glycerol and fatty acids. This process typically occurs in the adipose tissue and is triggered by various hormones, including glucagon and...
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
Diabetic Ketoacidosis ll: Pathophysiology
Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
Effect of Hepatic Disease on Pharmacokinetics: Active Drug, Metabolite and Fraction of Metabolized Drug
Diabetic Ketoacidosis l: Introduction

