Standardized Protocol for Early Cardiometabolic Assessment in Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with chronic low-grade inflammation and an increased risk of cardiovascular disease. Early identification of subclinical cardiometabolic alterations remains challenging because standardized protocols integrating dietary inflammatory assessment with objective cardiovascular imaging are limited. This protocol describes a reproducible workflow for evaluating the association between dietary inflammatory potential and early cardiometabolic alterations in adults with confirmed MASLD. Participants are enrolled according to standardized eligibility criteria, and hepatic steatosis is confirmed by ultrasonography. Dietary intake is assessed using a validated semi-quantitative food frequency questionnaire (FFQ), from which the Dietary Inflammatory Index (DII) is calculated using the original literature-derived methodology. Cardiometabolic assessment includes anthropometric measurements, fasting biochemical analyses, calculation of the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and the Atherogenic Index of Plasma (AIP), enzyme-linked immunosorbent assay (ELISA) quantification of inflammatory biomarkers, transthoracic echocardiographic assessment of left ventricular diastolic function using tissue Doppler-derived E/e', and bilateral carotid ultrasonography for measurement of carotid intima-media thickness (CIMT). Standardized acquisition procedures, predefined quality-control checkpoints, and data-validation steps are incorporated to ensure methodological consistency and reproducibility. Representative results demonstrate the standardized data generated by the protocol, including DII classification, inflammatory biomarker profiles, echocardiographic indices, and CIMT measurements, and do not imply confirmatory biological associations. This protocol provides a detailed, reproducible methodological framework for conducting clinical and translational studies investigating the relationship between dietary inflammatory burden and early cardiometabolic alterations in adults with MASLD.