Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, affecting nearly one-third of the global population (). Lifestyle modification, including nutritional intervention, remains the cornerstone of MASLD management. Although weight loss of >7%−10% is recommended to improve liver histology and metabolic outcomes, individual responses to dietary interventions vary considerably, reflecting the heterogeneous clinical, metabolic, and biological characteristics of the disease.
Precision nutrition has emerged as a promising framework to address this heterogeneity by integrating lifestyle and behavioral factors, body composition, metabolic biomarkers, environmental exposures, cultural preferences, and genomic, molecular, and microbiome-related characteristics into individualized nutritional approaches (). As illustrated in Figure 1, precision nutrition in MASLD encompasses a continuum from multidimensional patient characterization and integrated patient assessment to the implementation of personalized dietary and lifestyle interventions aimed at improving both hepatic and extrahepatic outcomes.
Figure 1
The articles assembled in this Research Topic illustrate how the principles of precision nutrition can be translated into practical strategies for the management of MASLD.
Integrated patient assessment as a cornerstone of precision nutrition
The marked heterogeneity partly explains why uniform nutritional recommendations often produce variable responses in MASLD. Integrated patient assessment provides a framework to identify clinically meaningful sources of heterogeneity that may influence disease progression and response to dietary interventions. Metabolic and inflammatory phenotyping are key components of this multidimensional assessment. In this context, Ntikoudi emphasizes that clinically meaningful metabolic and inflammatory profiles can be identified using readily available biomarkers, such as HOMA-IR, TG/HDL-C, and hs-CRP, without necessarily relying on complex omics technologies.
Along similar lines, Priego-Parra et al. () highlighted the triglyceride-glucose-waist circumference (TyG-WC) index as a practical surrogate of insulin resistance, visceral adiposity, and cardiometabolic risk, illustrating how accessible metabolic biomarkers can guide personalized nutritional management in MASLD. These advances reinforce the growing role of simple metabolic and nutritional biomarkers in refining patient assessment and guiding precision nutrition.
Metabolic and nutritional biomarkers in precision nutrition
Accessible metabolic and nutritional biomarkers are emerging as key tools for refining integrated patient assessment and improving risk stratification in MASLD. In this context, Cheng and Wang demonstrated that the single-point insulin sensitivity estimator (SPISE), a surrogate marker of insulin sensitivity derived from routinely available clinical parameters, was inversely associated with both prevalent and incident MASLD. Similarly, Xuan et al. identified the fasting blood glucose-to-high-density lipoprotein cholesterol ratio as another accessible metabolic biomarker associated with MASLD risk. Complementing these findings, Song et al. showed that several non-conventional lipid-derived indices, particularly TyG-BMI, performed excellently in identifying individuals with steatotic liver disease, further supporting the use of simple, readily available biomarkers in metabolic risk assessment. Expanding beyond insulin resistance-related indices, He et al. identified a U-shaped association between plasma homocysteine and incident MASLD, with both low and high concentrations associated with increased risk, suggesting that one-carbon metabolism may represent an additional metabolic pathway contributing to disease susceptibility.
Nutritional status also represents an important dimension of integrated patient assessment. Guo et al. demonstrated that higher geriatric nutritional risk index (GNRI) values were consistently associated with an increased risk across major MASLD subtypes, including diabetes-related, overweight/obesity-related, and lean MASLD, in older adults.
Dietary patterns and nutritional exposures
Beyond its role as a relevant therapeutic intervention, diet has been recognized as a significant contributor to the development of MASLD and a major modifiable risk factor. In this context, Qiu et al. showed that greater adherence to the Planetary Health Diet Index (PHDI) was associated with a lower likelihood of MASLD, with the effect partly mediated by body mass index and waist circumference. In addition, Yang et al. demonstrated that greater adherence to the MIND Diet Score was associated with improved hepatic and metabolic health together with a more favorable gut microbiota profile, supporting the potential role of comprehensive dietary quality indices in precision nutrition. Siani et al. further reported an inverse, dose-dependent association between Italian-style coffee consumption and MASLD risk, with lower odds observed as daily coffee intake increased. Although this observational study does not establish causality, it highlights the potential relevance of specific dietary exposures in modulating MASLD risk. Taken together, these studies reinforce the importance of dietary quality and selected nutritional exposures in MASLD and support the inclusion of both overall dietary patterns and individual dietary components in nutritional assessment.
Mechanistic insights supporting targeted interventions and future directions
Dietary interventions, reduced intake of sugar-sweetened beverages (Li et al.), and regular physical activity improve metabolic health and body composition while modulating key pathways involved in disease progression, including insulin resistance, systemic inflammation, and gut microbial ecology. Growing evidence positions the gut microbiota as a key mediator linking environmental exposures with hepatic and metabolic dysfunction. Within this framework, diet should be considered not only as a source of nutrients but also as a therapeutic modulator of host–microbiome interactions. Bioactive components, including omega-3 fatty acids, coffee, tea, and fermented foods, have been associated with favorable metabolic and microbial profiles, although their molecular mechanisms remain incompletely understood.
These effects are closely related to the gut–liver axis, through which microbial metabolites and microbial-associated molecular patterns influence hepatic homeostasis. During dysbiosis, increased exposure to lipopolysaccharides, altered bile acid metabolism, and other microbial products may promote adipose tissue dysfunction, oxidative stress, mitochondrial impairment, and chronic inflammation, thereby supporting dietary and microbiota-targeted approaches as therapeutic strategies ().
Pharmacological therapies complement lifestyle interventions by targeting metabolic, inflammatory, fibrotic, and immune-related pathways, including PPAR, GLP-1 receptor, SGLT2, FXR, DPP-4, FGF, and related signaling pathways (). Additionally, some supplements, such as carnitine, have shown therapeutic potential, as highlighted by Chen C. et al.
Beyond current therapies, NLR inflammasome activation has emerged as a potential mechanistic link between dysbiosis and metabolic inflammation, supporting future strategies to modulate immune-metabolic pathways ().
Translating these advances into clinical practice will require a precision-medicine framework that goes beyond conventional disease classification. Metabolic and inflammatory phenotyping may identify biologically distinct subgroups and guide targeted interventions. Chen H. et al. further showed that intermittent fasting may exert metabolic and gene-expression effects beyond those of caloric restriction alone.
Collectively, these advances support a shift from a liver-centered view of MASLD toward a systems-based framework integrating host metabolism, immunity, and the intestinal microbiome. This perspective aligns with the concept of the human holobiont and may facilitate the development of more precise and biologically informed therapeutic strategies.
Conclusions
Lifestyle modification remains the cornerstone of MASLD management, with dietary intervention and increased physical activity representing the foundation of current therapeutic strategies. However, substantial interindividual variability in treatment response highlights the limitations of a uniform approach. Integrating precision nutrition into clinical care offers an opportunity to tailor dietary interventions according to each patient's metabolic phenotype, body composition, comorbidities, lifestyle, and, where appropriate, multi-omics data. Such an individualized approach has the potential to improve adherence, maximize metabolic and hepatic benefits, and ultimately enhance long-term disease management.
Statements
Author contributions
BR-C: Writing – original draft, Writing – review & editing. BP-P: Writing – original draft, Writing – review & editing. CM-C: Writing – original draft, Writing – review & editing.
Acknowledgments
The Topic Editors gratefully acknowledge the contributions of all authors and reviewers whose efforts made this Research Topic possible. We also sincerely thank Edward Teggin and the Frontiers team for their guidance and support throughout the editorial process.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author BR-C declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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Summary
Keywords
dietary interventions, MASLD, metabolic biomarkers, nutrition precision, nutritional assessment
Citation
Román-Calleja BM, Priego-Parra BA and Martínez-Cabrera CF (2026) Editorial: Precision nutrition and dietary interventions in the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Front. Nutr. 13:1924585. doi: 10.3389/fnut.2026.1924585
Received
30 June 2026
Revised
15 July 2026
Accepted
16 July 2026
Published
29 July 2026
Volume
13 - 2026
Edited and reviewed by
Sonia Roman, University of Guadalajara, Mexico
Updates
Copyright
© 2026 Román-Calleja, Priego-Parra and Martínez-Cabrera.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Berenice M. Román-Calleja, berenice.romanc@incmnsz.mx
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.