Personalized Dietary Feedback to Reduce Hepatic Steatosis in Patients With MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) and combined metabolic dysfunction and alcohol-associated liver disease (MetALD) are common chronic liver diseases associated with metabolic dysfunction and an increased risk of liver-related and cardiovascular complications. Lifestyle modification, particularly dietary changes and increased physical activity, represents a cornerstone of treatment. However, general lifestyle recommendations are often insufficient to achieve sustained improvements. This prospective, randomized controlled trial aims to investigate whether personalized dietary and lifestyle feedback based on a structured questionnaire is more effective in reducing hepatic steatosis than generic lifestyle recommendations. A total of 174 patients with MASLD or MetALD will be randomized 1:1 to receive either personalized or generic written feedback at baseline and after 2, 4, and 6 months. Changes in hepatic steatosis, assessed by the controlled attenuation parameter (CAP), will be evaluated over a six-month period.

Inclusion Criteria: * Age 18-80 years. * Controlled attenuation parameter (CAP) \>248 dB/m. * Sufficient German language proficiency to independently complete the questionnaires. * Written informed consent to participate in the study. Exclusion Criteria: * Other active chronic liver disease. * Significant alcohol consumption, defined as ≥50 g/day in women or ≥60 g/day in men. * Pregnancy or breastfeeding. * Type 1 diabetes mellitus. * Initiation or dose modification of GLP-1 receptor agonists or other weight-modifying pharmacological therapies within the previous three months. * Planned bariatric surgery during study participation. * Severe or unstable medical condition that, in the investigator's judgment, may interfere with study participation or interpretation of study results.