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Weight loss diets and macronutrient intake in MASLD: A cross-sectional analysis of the U.S. population
Matthew W Ewy1, Elizabeth C Townsend2, Adnan Said1
1Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA.
Background:
Key dietary patterns targeting Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) generally emphasize caloric restriction. However, dietary differences between individuals with and without MASLD remain unclear. This population-based cross-sectional study compares self-reported dietary patterns between individuals with and without MASLD in the US.
Methods:
We analyzed 2017-2018 National Health and Nutrition Examination Survey (NHANES) data on adults (≥18) with and without MASLD. Self-reported low-calorie diets versus no specific diet were examined. Dietary intake was assessed via 24-hour recalls.
Results:
The NHANES survey included 5856 adults, 1566 (26.7%) of whom met criteria for MASLD. Among MASLD participants, 11.2% (175/1566) reported following a low-calorie diet compared to 7.5% (180/2401) of non-MASLD controls (p < 0.001). Within the low-calorie group, MASLD participants reported higher caloric intake than controls (2159 vs. 1883 kcals; p = 0.004), carbohydrates (242 vs. 205 g; p < 0.001), and fat (90 vs. 76 g; p = 0.04). Among all adults with MASLD, caloric intake did not differ by diet status (low calorie dieters vs non-dieters) (2205 vs. 2159 kcals; p = 0.545) although the non-dieters consumed more sugar (114 vs. 93 g; p = 0.01) and the diet group consumed more sodium (3897 vs 3587 mg/d; p = 0.03).
Conclusions:
Among participants reporting low-calorie diets, MASLD participants consumed more calories, particularly from fats and carbohydrates, than non-MASLD controls. Nutrient profiles were similar regardless of dieting status in MASLD participants. These findings suggest that self-reported dietary adherence may not always reflect actual dietary intake. Given the central role of diet in MASLD outcomes, inconsistencies in dietary composition may partially explain variability in placebo responses observed in clinical trials. These findings need further confirmation to inform improvements in trial designs and intervention strategies.