Gluten-free diet may improve liver, metabolic parameters in MASLD

Following an amylase trypsin inhibitors (ATI)-free diet for 6 weeks appears to produce substantial improvements in liver and metabolic, as well as patient-reported outcomes, in people with metabolic dysfunction-associated steatotic liver disease (MASLD), according to a proof-of-concept study.

The study included 45 consecutively enrolled patients with biopsy-proven MASLD. These patients were randomly assigned to undergo a 6-week ATI-free diet intervention (n=21) or a balanced diet intervention as recommended by the German Nutrition Society (control, n=24). Those in the ATI-free diet arm had to avoid dietary sources of gluten, mainly wheat, to achieve a >90-percent reduction in daily regular ATI intake, from a daily average of 0.7 g (20 g gluten) to <0.05 g ATI per day.

Researchers evaluated changes in controlled attenuation parameter (CAP), body mass index (BMI), and homeostatic model assessment of insulin resistance (HOMA-IR). Patient-reported outcomes were assessed using the Chronic Liver Disease Questionnaire for Nonalcoholic Steatohepatitis (CLDQ-NASH) questionnaire.

A total of three patients from each arm withdrew from the study. Compared with the control arm, the ATI-free diet arm had a significant reduction from baseline in BMI (p=0.018), CAP (p=0.018), and HOMA-IR (p=0.042) at 6 weeks.

The median difference in CAP between the ATI-free diet and control arms was 30.5 points (p=0.039), with the observed decrease in delta CAP significantly greater in the ATI-free diet arm (p=0.043).

CLDQ-NASH domains showed significant improvements in the ATI-free diet arm but not in the control arm (p=0.013 for total scoring).