Short-Term Changes in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Related Circulating Biomarkers Following a Very-Low Calorie Ketogenic Diet (VLCKD): A Paired Longitudinal Analysis

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide. Its prevalence is constantly increasing, particularly among obese individuals. Lifestyle modifications remain the first-line intervention for the management and treatment of MASLD. The most widely recommended dietary regime for MASLD is the Mediterranean Diet (MedDiet). Despite its countless benefits, this dietary regimen is difficult to follow in some cases. This study aimed to assess the effects of an 8-week Very Low-Calorie Ketogenic Diet (VLCKD) in obese patients with MASLD. Methods: The study included 55 obese adults aged 18–64 years, recruited from the Center of Nutrition for Obesity and Metabolic Diseases, National Institute of Gastroenterology “Saverio de Bellis” Research Hospital (Castellana Grotte, Bari, Italy). Anthropometry, body composition (BIA), liver status (FibroScan®), serum biochemistry and circulating biomarkers of adipose dysfunction were assessed at baseline (T0) and post-intervention (T1). Results: Significant improvements in liver steatosis (CAP p < 0.0001), liver stiffness (p = 0.0005), anthropometric parameters (waist p < 0.0001), and body composition (FM p <0.0001) were observed. A significant reduction in leptin levels and an increase in sex hormone-binding globulin (SHBG p < 0.0001) were also observed. Conclusions: In this uncontrolled pre-post analysis, the 8-week VLCKD intervention was associated with improvements in hepatic steatosis, body weight, and fat mass, and selected circulating biomarkers of adipose tissue dysfunction in adults with obesity and MASLD.