Micronutrients in the Supportive Management of Metabolic Dysfunction–Associated Steatotic Liver Disease and Dyslipidemia: Current Evidence, Mechanisms, and Future Prospects

Metabolic dysfunction–associated steatotic liver disease (MASLD) and dyslipidemia are interconnected metabolic conditions associated with insulin resistance, adipose tissue dysfunction, oxidative stress, and chronic low-grade inflammation. Micronutrients have attracted attention because of their physiological roles in antioxidant defenses, one-carbon metabolism, mitochondrial function, and immune regulation. This narrative review examines the mechanistic rationale and clinical evidence for vitamin E, vitamin D, vitamins B6/B9/B12, zinc, selenium, and the related nutrients choline and omega-3 fatty acids. The PIVENS trial identified histological benefits of vitamin E in selected adults with non-diabetic steatohepatitis, whereas evidence for routine supplementation with other micronutrients remains insufficient. Omega-3 fatty acids can lower triglycerides but should not be regarded as proven antifibrotic therapy. Major challenges include heterogeneous trial populations, surrogate endpoints, baseline nutritional status, dose-related toxicity, and limited long-term outcome data. Future studies should integrate nutritional phenotyping, validated liver outcomes, and randomized trials to establish whether targeted correction of deficiency improves clinical outcomes beyond established lifestyle and cardiometabolic interventions.