Diet Quality Emerges as Key Social Determinant in MASLD Severity and Prevalence

A systematic review and meta-analysis published in The American Journal of Gastroenterology highlights diet quality as the most consistently associated social determinant of health (SDOH) influencing both the prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in U.S. adults. The study synthesizes data from 18 studies and more than half a million subjects to better characterize how non-biologic factors contribute to MASLD burden.

Researchers analyzed U.S.-based studies published between January 2010 and May 2024, focusing on SDOH factors beyond race and ethnicity. Key outcomes included MASLD and MASH (metabolic dysfunction-associated steatohepatitis) prevalence, MASH-associated advanced fibrosis or cirrhosis, and clinical outcomes.

“High diet quality was the most consistent SDOH factor associated with both MASLD and MASH-associated advanced fibrosis/cirrhosis prevalence,” the authors reported. The summarized odds ratios were 0.76 (p < 0.01) for MASLD and 0.74 (p < 0.01) for advanced fibrosis/cirrhosis, indicating a protective effect of healthier dietary patterns.

Other SDOH, such as income level, housing status, or education, showed inconsistent associations with disease burden. However, lower income was more frequently linked to worse clinical outcomes, reaching statistical significance in 3 of 9 studies that evaluated these outcomes.

Of the 18 included studies, 9 assessed MASLD prevalence, 3 examined MASH prevalence, 6 evaluated advanced fibrosis or cirrhosis, and 9 reported on clinical outcomes. The data were drawn from 11 unique cohorts, encompassing 547,634 individuals.

“Prospective assessments using consensus, validated tools to assess the impact of specific SDOH on MASLD burden in heterogenous patient populations are needed,” the authors stated, emphasizing the need for standardized approaches to evaluating social risk factors in liver disease research.

For clinicians treating MASLD, these findings underscore the importance of incorporating dietary assessments and interventions into care plans, particularly in underserved populations. This study supports a growing body of evidence pointing to modifiable lifestyle factors as critical targets for reducing disparities in chronic liver disease outcomes.

Reference
Abu-Rumaileh M, Dhoop S, Pace J, et al. Social determinants of health associated with metabolic dysfunction-associated steatotic liver disease prevalence and severity: a systematic review and meta-analysis. Am J Gastroenterol. Published online March 17, 2025. doi:10.14309/ajg.0000000000003421