ArticleDiabetology & metabolic syndrome2026
Higher adherence to the EAT-lancet diet is associated with reduced risk of metabolic dysfunction-associated steatotic liver disease: a 5-year middle eastern cohort study.
Article in Diabetology & metabolic syndrome, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is a rapidly increasing metabolic disorder worldwide. Sustainable dietary patterns such as the EAT-Lancet Diet (ELD), designed to promote both human and planetary health, may help prevent MASLD; however, prospective evidence from Middle Eastern populations remains limited.
methodsThis prospective cohort study included 5,058 Iranian adults aged 20-70 years from the MMRT study who were free of MASLD at baseline. Dietary intake was assessed using a validated 125‑item food frequency questionnaire, and adherence to the ELD was quantified using the Planetary Health Diet Index (PHDI). Incident MASLD over a 5‑year follow‑up was defined using hepatic steatosis (CAP ≥ 238 dB/m) in the presence of metabolic dysfunction. Multivariable logistic regression, restricted cubic splines, and mediation analyses were applied.
resultsDuring follow‑up, 562 participants developed MASLD, yielding a 5-year cumulative incidence of 11.1%. In fully adjusted models, individuals in the third and fourth quartiles of PHDI had 39% (OR 0.61; 95% CI 0.45-0.81) and 34% (OR 0.66; 95% CI 0.50-0.88) lower odds of MASLD, respectively, compared with the lowest quartile (P‑trend < 0.001). Each one‑standard‑deviation increase in PHDI was associated with a 16% lower MASLD risk (OR 0.84; 95% CI 0.76-0.94). The inverse relationship was largely linear, with a suggestive plateau at higher PHDI scores (P for non-linearity = 0.08). Mediation analyses indicated substantial contributions from dietary fiber (71.4%), HOMA‑IR (69.3%), CAP (53.8%), and CRP (44.0%).
conclusionsGreater adherence to a PHDI was associated with lower MASLD risk in Iranian adults, potentially through improvements in insulin resistance, inflammation, hepatic steatosis, and dietary fiber intake.
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