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World J Hepatol. Aug 27, 2025; 17(8): 107909
Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.107909
Table 1 Summary of myths and facts
Myth
Main message
All carbohydrates are harmfulThe type of carbohydrate matters. Complex carbohydrates rich in fiber are protective, while excessive consumption of simple sugars, especially fructose, is associated with increased hepatic lipogenesis
Fats should be eliminated from the dietThe quality of fat is more important than quantity. Monounsaturated and polyunsaturated fats have anti-inflammatory and hepatoprotective effects, while trans fats and saturated fats should be minimized
Only the number of calories matters, not the quality of foodIsocaloric diets with different nutritional compositions have distinct effects on liver health. Diet quality impacts steatosis regardless of caloric balance
Any weight loss already improves MASLDAlthough modest weight loss (3%-5%) can reduce hepatic steatosis, a reduction of ≥ 7%-10% is necessary to achieve regression of inflammation and fibrosis
People with normal weight don't need to worry about their dietMASLD can also affect individuals with normal BMI ("lean MASLD"), representing up to 20% of cases and equally susceptible to disease progression
Intermittent fasting is contraindicatedStrategies such as intermittent fasting can promote weight loss, improve insulin sensitivity, and reduce liver fat when properly guided and monitored
Supplements and "superfoods" can cure MASLDThere is no dietary supplement or isolated food with robust evidence of efficacy in reversing MASLD; none can replace a comprehensive dietary and behavioral approach
Herbal teas and supplements are always safe and help "cleanse" the liverMost herbal substances lack scientific evidence of efficacy and may cause liver toxicity. Many cases of acute hepatitis and liver failure are associated with "natural" supplements
Coffee is harmful for people with fatty liverBlack coffee has hepatoprotective effects and may slow disease progression. Drinking 2-3 cups per day is potentially beneficial for most patients with MASLD
Iron-rich foods should be avoided when ferritin is elevated in MASLDElevated ferritin levels in MASLD patients usually reflect inflammation and insulin resistance rather than true iron overload. Dietary iron restriction is rarely indicated
Red meat can be consumed freely in MASLDExcessive consumption of red meat, especially when processed or prepared at high temperatures, has been associated with worsening hepatic steatosis and inflammation
Gluten and lactose must be eliminated from the diet in MASLDThe exclusion of gluten and lactose is not routinely recommended unless the patient has a confirmed diagnosis of celiac disease, lactose intolerance, or non-celiac gluten sensitivity
There is a "safe" dose of alcoholic beverageEven small amounts of alcohol can have a harmful effect on the liver in patients diagnosed with hepatic steatosis. Total abstinence is recommended for individuals with hepatic steatosis