Weight loss is associated with improved vascular function in patients with metabolic dysfunction-associated steatotic liver disease

1. Short-term dietary weight loss targeting hepatic fat reduction was associated with measurable improvements in arterial stiffness, endothelial function, and cardiovascular risk scores in metabolic dysfunction-associated steatotic liver disease (MASLD) patients.

2. These vascular improvements did not correlate directly with the magnitude of hepatic triglyceride reduction, suggesting the vascular benefits may occur through mechanisms independent of liver fat content itself.

Evidence Rating Level: 1 (Excellent)

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a cardiovascular risk factor, yet whether reducing hepatic triglycerides directly improves vascular function remains unclear. This two-week, randomized, pre-post trial enrolled 47 adults (mean age 54, 81% female) with or at high risk for MASLD, assigned to either a low-carbohydrate (<30 g/day) or low-calorie (~1,200–1,500 kcal/day) diet. Hepatic triglyceride content was quantified via MRI-proton density fat fraction, while arterial stiffness (pulse wave velocity) and endothelial function (flow-mediated dilation, FMD) were assessed pre- and post-intervention. Both diets produced comparable reductions in hepatic triglycerides (–15% relative to baseline). Brachial-ankle PWV decreased significantly (–41 cm/s), FMD improved by ~1%, and Framingham Risk Score declined, alongside reductions in body weight, insulin resistance, and inflammatory markers (IP-10). Notably, hepatic triglyceride reduction correlated with decreased resting heart rate (r=0.35 after adjustment for age/weight) but not with changes in vascular stiffness or endothelial function measures.

Click here to read this study in PLOS One

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