In a case-control study of 111 adults attending a diet clinic in Turkey, consuming less than one fish serving per week (OR: 4.51), fewer than two legume servings per week (OR: 6.03), and fewer than two fruit servings per day (OR: 6.20) were each independently associated with significantly higher odds of metabolic dysfunction-associated steatotic liver disease (MASLD), even after adjusting for age, sex, energy intake, and BMI. Cases also showed higher carbohydrate intake, an elevated n-6/n-3 fatty acid ratio, lower MUFA and PUFA proportions, and were less likely to eat breakfast regularly or use olive oil.
MASD — formerly called NAFLD — now affects roughly 25–30% of adults globally and is increasingly recognized as a driver of cirrhosis, hepatocellular carcinoma, and cardiovascular mortality. These findings align with a growing body of evidence supporting Mediterranean-style dietary patterns, which emphasize fish, legumes, fruit, and olive oil, as protective against hepatic fat accumulation. The mechanistic logic is sound: omega-3 fatty acids reduce hepatic lipogenesis, legumes improve insulin sensitivity, and fruit polyphenols modulate oxidative stress. However, this study carries critical limitations: with only 56 cases and 55 controls recruited from a single diet clinic, statistical power is modest and selection bias is substantial. The cross-sectional design precludes causal inference — dietary recall data may also reflect post-diagnosis behavior change. Confirmatory prospective cohort work is needed before firm dietary recommendations specific to MASLD prevention can be issued.