A very low-energy ketogenic diet (VLED) has achieved a 77% reduction in liver fat among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD), a significant improvement over the 14% reduction observed with a Mediterranean diet (MD) in a randomized trial. MASLD, the most common liver disease, is closely linked to obesity and type 2 diabetes, making weight loss critical for management.
The pilot study involved 25 adults with MASLD. Over 12 weeks, the ketogenic VLED group consumed 3,151 kJ daily, while the MD group had 8,950 kJ. The VLED group experienced a 77% decrease in liver fat measured by MRI, compared to 14% in the MD group. Notably, 69% of VLED participants normalized their liver fat levels, a benchmark not met by anyone in the MD group.
Weight loss was a key factor, with VLED participants losing a median of 13% of their body weight, versus 4% for the MD group. This substantial weight loss in the VLED group correlated with reduced visceral and subcutaneous fat. After 12 weeks, the VLED group began semaglutide for weight maintenance, sustaining a 14% total body weight loss by week 24.
While the study acknowledges limitations including its small sample size and unblinded nature, it suggests that a ketogenic VLED, possibly combined with pharmacological support, could be an effective strategy for rapid weight and liver fat reduction in MASLD patients.