Comparative efficacy of dietary patterns on glycemic and liver enzymes in metabolic dysfunction-associated steatotic liver disease: a network meta-analysis

Insulin resistance and hepatic dysfunction are strongly associated with metabolic dysfunction-associated steatotic liver disease (MASLD). Non-pharmacological approaches, particularly dietary interventions, have demonstrated considerable potential for mitigating these conditions. In this network meta-analysis (NMA), we compared the relative efficacy of different dietary patterns on glycemic regulation and hepatic enzyme profiles. A comprehensive systematic search of PubMed, Scopus, Web of Science, Cochrane, and Google Scholar was conducted from inception to March 2025. The NMA was carried out based on both direct and indirect comparisons using random-effects models. Pooled analysis on 25 RCTs showed that DASH diet was more effective in reducing HOMA-IR (MD = -0.60; 95% CI: -1.14, -0.05; P-scores = 0.76; p = 0.03), AST (MD = -4.99; 95% CI: -8.76, -1.21; P-scores = 0.23; p = 0.009), compared to placebo. Low-Glycemic-Index Mediterranean Diet (LGIMD) approach led to a statistically significant but not clinically meaningful decrease in A1C levels compared to the placebo (MD = -0.01%; 95% CI: -0.01, -0.005; P-scores = 0.42; p < 0.001). The Mediterranean diet (MD) significantly reduced ALT levels compared with placebo (MD = -10.21; 95% CI: -20.22 to -0.20; p = 0.04; P-score = 0.70). The present NMA indicates that dietary interventions, including the Mediterranean diet, DASH, and certain low-glycemic approaches, are effective strategies for the management of MASLD. However, a LGIMD has shown mixed glycemic effects (reduction in A1c but increase in HOMA-IR), which warrant careful interpretation and further investigation.