Effects and Mechanisms of Stevioside on Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects more than 30% of adults globally and has emerged as a significant public health concern. Stevioside (SV), as a noncaloric sweetener derived from natural sources, has been reported to have beneficial effects on MASLD in several studies. Given that SV is widely used as a food sweetener, clarifying its effects on MASLD is of importance for controlling the increasing disease burden of MASLD. However, the hepatoprotective effects and molecular mechanisms of SV remain inconclusive, highlighting the need for a comprehensive review to summarize the best available evidence. We therefore conducted a systematic review of preclinical and clinical studies to critically assess the effects of SV on MASLD and to evaluate the underlying mechanisms in detail. We performed a comprehensive search of PubMed and Web of Science (up to February 20, 2025) and included a total of two clinical trials, 36 animal studies, and two cellular studies for review. Results from preclinical studies demonstrated that SV could prevent or treat MASLD by improving hepatic lipid metabolism, enhancing anti-inflammatory and antioxidant capacity, and attenuating hepatic fibrosis. Yet the evidence from clinical trials regarding the beneficial effects of SV on MASLD was sparse and inconsistent, requiring further exploration. In conclusion, SV represents a promising dietary strategy for the potential prevention and treatment of MASLD, provided its hepatoprotective effects are validated in clinical trials and population studies.