Daily Tomato Intake May Lower Liver Fat in People With MASLD, New Study Suggests
Key Takeaways:
- In a six-week randomised study of 79 adults with metabolic dysfunction-associated liver disease (MASLD), people who ate 200 grams of raw tomatoes and 50 grams of tomato sauce each day showed a greater reduction in hepatic steatosis than people following a tomato-free control diet.
- Liver fat fell in both groups, and researchers found no meaningful differences between the groups in liver stiffness, liver enzymes, lipids or body mass index after the intervention period.
- Independent specialists described the findings as exploratory rather than practice-changing, noting the short duration, the narrow participant profile and the absence of improvement in clinically relevant markers.
What the research set out to examine
Metabolic dysfunction-associated liver disease (MASLD) covers a spectrum of liver problems, but its defining feature is hepatic steatosis – the accumulation of fat within the liver. A diagnosis also requires the presence of at least one cardiometabolic risk factor, such as obesity or high blood pressure.
Diet and lifestyle changes are a mainstay of support for people living with MASLD, and researchers are increasingly interested in whether particular foods offer measurable advantages over others. A study published in Nutrients set out to test one such food: the tomato, a staple of the Mediterranean diet.
The research team wanted to establish whether regular tomato consumption would influence liver steatosis in people who already had a MASLD diagnosis.
How the study was designed
The study enrolled 79 adults with MASLD. Researchers applied a number of exclusion criteria, ruling out people who consumed above a set threshold of alcohol and those with a body mass index above 30, the point at which obesity is classified.
Participants were divided into two groups. One group followed a tomato-free control diet. The other consumed 200 grams of raw tomatoes and 50 grams of tomato sauce daily. All tomato products were supplied by the same producer to keep the intervention consistent, and participants were asked to carry on with their usual lifestyle in every other respect.
The intervention ran for six weeks. Across that period, researchers tracked a range of health indicators, including body composition, hepatic steatosis, liver stiffness and cholesterol levels.
What the researchers found
Hepatic steatosis declined in both groups over the six weeks. The decrease was greater, however, among people in the tomato group.
Further analysis showed that hepatic steatosis had been broadly similar between the two groups at baseline, which strengthens the comparison. Other measures told a quieter story. Researchers identified no major changes in liver stiffness, and no significant differences between the groups in lipids, liver enzymes or body mass index at the end of the six-week period.
Summarising the result, the authors suggested that “tomato consumption may reduce hepatic fat accumulation independently of major changes in body weight, total and abdominal adiposity.”
Because liver fat shifted while weight and body composition did not, the study raises a familiar practical question for clinicians: how far can dietary composition alone move metabolic outcomes when overall energy intake stays broadly the same? It is the kind of question CCH explores in its CPD short course Nutrition & Weight Management Essentials, which examines the relationship between modern nutrition and weight, and how evidence-based dietary advice translates into everyday clinical conversations.
Study limitations and continued research
The six-week window is short, so the study cannot speak to whether any benefit persists over the longer term. The research also recruited only adults aged 65 and under, leaving it unclear how the findings might apply to older adults.
Most participants were men, so more balanced recruitment would strengthen future work. The decision to exclude people with a body mass index above 30 also narrows how widely the results can be applied.
Endocrinologist and obesity specialist Randa Abdelmasih MD, DipABOM, from the University of Texas Medical Branch (UTMB), who was not involved in this study, told Medical News Today:
“The study demonstrates a modest reduction in hepatic steatosis over only six weeks in a highly selected population of adults with MASLD and BMI [body mass index] of 30 kg/m² [kilograms per square meter] or more. Most patients we see in clinical practice have obesity (BMI over 30 kg/m²), type 2 diabetes, or more advanced metabolic disease, so the generalizability of these findings is limited.”
Jonathan Jennings, MS, MD, a board-certified internist with Medical Offices of Manhattan, who was likewise not involved in the research, raised a related concern about how participants were selected.
“The inclusion criteria required only one cardiometabolic risk factor, and it could be any risk factor. I am concerned that not all risks are equal, and people with multiple factors are at higher risk than those with a single risk factor,” Jennings said.
“Type 2 diabetes is more likely to lead to MASLD than high blood pressure but the study evaluates them as equal risk factors,” he pointed out.
The researchers themselves note that the reduction in liver fat may have been influenced by other factors, including the effect that taking part in a dietary intervention study can have on participants’ behaviour. The team was also reliant on dietary counselling and on participants’ own reports of how closely they followed the intervention.
Abdelmasih added that because the intervention combined raw tomatoes with tomato sauce, it is “difficult to determine which component or combination was responsible for the observed effect.”
A further gap is that researchers did not measure circulating levels of lycopene and carotenoids, the compounds most often proposed as the mechanism behind any effect tomatoes might have on liver health.
Limited clinical application at this stage
The authors describe their study as exploratory, intended primarily to inform future research. They call for confirmation through larger and longer studies, and encourage readers to treat the findings as hypothesis-generating rather than conclusive.
The clinical value is also uncertain because so much else stayed the same. As Abdelmasih put it:
“The study showed improvement in liver fat but no significant improvements in liver stiffness, fibrosis scores, liver enzymes, insulin resistance, inflammatory markers, lipid profile, or body composition. Therefore, while the imaging findings are interesting, we cannot conclude that tomato consumption meaningfully alters disease progression or improves clinically relevant outcomes.”
What this means for people living with MASLD
Within its limits, the study does point to a possible benefit of tomato consumption for people with MASLD, and to a low-cost dietary strategy that may help with fat accumulation in the liver.
Tomatoes may carry other advantages too, with existing research pointing towards cardiovascular benefits and potential anti-cancer properties.
Even so, the sensible route is for people to work with their doctor and wider healthcare team on a dietary plan that addresses their overall health, rather than concentrating on any single food.
Jennings underlined that point, and flagged two practical cautions:
“The study’s conclusions are hopeful but careful discussion with a healthcare provider is still needed before engaging in any radical dietary adjustments. Tomatoes and tomato-based products may be problematic for individuals with gastroesophageal reflux disease (GERD). Many tomato-based foods are also calorically dense and may worsen insulin resistance in certain individuals.”
The broader treatment context matters as well. According to Abdelmasih: “Dietary interventions should be viewed within the broader context of treating the underlying metabolic disease. For patients with obesity, sustained weight loss of approximately 10% or more remains the intervention with the strongest evidence for improving steatohepatitis and fibrosis.”
“While tomatoes can certainly be part of a healthy Mediterranean diet, they should not distract from therapies that have demonstrated meaningful improvements in liver and cardiometabolic outcomes,” she concluded.
CCH insight
Conversations about diet sit at the centre of metabolic and liver care, and single-food headlines can make those conversations harder rather than easier. CCH’s CPD short course Nutrition & Weight Management Essentials gives healthcare professionals a grounding in the fundamentals of nutrition, the factors driving weight gain, and what effective weight management looks like in practice – so you can place findings like these in proportion for the people you support.
Explore Nutrition & Weight Management Essentials →
Expert commentary in this article was provided to Medical News Today. Read the original report here.
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Dual Burden of Alcohol Use and Obesity Linked to Rising Liver Disease Risk
Key Takeaways:
- Around 1 in 10 U.S. adults report both heavy drinking and obesity, creating a compounded risk for liver disease
- This overlap is most common in younger and middle-aged adults, suggesting risk accumulates early in life
- Integrated, non-judgemental care targeting both conditions together may improve long-term outcomes and reduce progression to advanced liver disease
A growing overlap with serious implications
Heavy alcohol use and obesity are both increasing in the United States, and they are increasingly affecting the same individuals. A new study published in JAMA Internal Medicine explores how often these two major risk factors coincide among U.S. adults and why this overlap has important implications for clinical care and public health policy.
The research was led by Dr Bryant Shuey, a board-certified general internist at UPMC and a clinician-investigator at the University of Pittsburgh Center for Research on Health Care. His work focuses on substance use, chronic disease, and access to care. Drawing on national survey data, the study highlights a critical, and often overlooked, opportunity to intervene earlier in the disease trajectory before severe liver damage develops.
Why examine alcohol use and obesity together?
Dr Shuey explains that this combined risk is increasingly visible in clinical practice:
“In my clinical work, I’ve been seeing more people in their 30s and 40s coming to the hospital with advanced liver disease linked to both alcohol use and metabolic risk factors. Nationally, heavy drinking and obesity are both becoming more common and there has been greater recognition that alcohol and metabolic disease can combine to accelerate liver disease progression. Treatment of both conditions, especially alcohol use disorder, is also lagging, as evident by research by my colleague and study co-author Dr. Eden Bernstein from the University of Colorado. Together, we sought to understand how often risky alcohol use and obesity overlap and what it might mean for prevention and earlier intervention.”
This convergence of risks reflects a broader shift in how liver disease is understood. Rather than being driven by a single cause, many people now present with multiple interacting factors that amplify disease progression.
A significant and early-emerging risk
The study’s central finding is clear:
“The key finding is that about 1 in 10 U.S. adults reported both heavy drinking and a body mass index of 30 or greater in 2023. That’s a substantial share of the population, especially considering how strongly each of these factors contributes to liver disease risk on its own.”
What is particularly striking is how early this overlap appears.
“What stood out most was how early this overlap appears. Rates were highest among young and middle-aged adults, when risk factors for serious liver disease are just beginning to build. These findings suggest that many people are entering adulthood with multiple, reinforcing risk factors for liver disease long before they ever develop symptoms.”
This suggests that prevention efforts may need to begin far earlier than is currently typical, focusing on identifying and addressing risk factors before clinical disease becomes apparent.
How liver disease presents in clinical practice
People living with alcohol-related and metabolically related liver disease may present at very different stages. Some are identified early through routine primary care assessments, while others present later with advanced complications.
Dr Shuey describes this spectrum:
“Patients can show up at different points along the disease course. Some are identified early by their primary care doctor by discussing risk factors like alcohol use and metabolic health and ordering blood work and liver imaging. Others present later, sometimes to the emergency department, with symptoms of advanced liver disease, or cirrhosis, like jaundice, abdominal swelling or gastrointestinal bleeding. Liver disease can lurk for years with no symptoms, so for some, that’s the first time they’re learning they have liver disease. Whether the illness is driven mainly by metabolic disease, alcohol use or a combination of both, if unchecked, the outcome can be the same: progressive liver damage that can lead to cirrhosis and liver failure. That’s why it’s so important to address these risk factors together, not in isolation.”
The silent progression of liver disease underscores the importance of proactive screening and early intervention.
Rethinking care: addressing both risks together
For clinicians, the findings point to the need for a more integrated approach to care.
“We need to routinely screen for both conditions in an empathetic and non-judgmental way and recognize how strongly they interact when it comes to liver disease risk. Clinicians should offer standard evidence-based options to treat both conditions: dietary counseling, motivational interviewing, medications for alcohol use disorder and therapies for metabolic disease such as GLP-1s and related weight loss drugs. There’s growing interest in these medications because they help people reduce their metabolic risk through weight loss and reversing inflammation in metabolic liver disease. Additionally, a smaller trial last year found that GLP-1s may reduce alcohol use among people with alcohol use disorder. While these results should not be overstated, GLP-1s may emerge as an important dual-therapeutic for patients with risky alcohol use and obesity if these findings hold up in larger trials. Ultimately, addressing both risk factors together may be an important strategy to change long-term outcomes.”
This reflects a shift towards dual-risk management, where treatment strategies are designed to address interconnected drivers of disease rather than isolated conditions.
Supporting people without judgement
A central theme in managing these conditions is the importance of person-centred care.
“The most important thing is creating space to talk about these concerns without judgment. I would want to learn about their goals, explore their understanding of the health impacts of alcohol use and metabolic disease, counsel them on treatment options and support them in their decision. For some people, the priority is avoiding serious illness down the road. Others may want to lose weight, drink less or stop drinking altogether. While addressing both conditions simultaneously may be of interest to some patients, others may feel overwhelmed and want to focus on just one. There isn’t a single right goal.”
This highlights the need for flexibility in care plans and respect for individual priorities and readiness for change.
Barriers to care and policy implications
The study also draws attention to wider structural barriers that influence health outcomes.
“Our social conditions shape our health. Improving access to affordable, healthy foods and safe spaces for exercise and activity can go a long way in helping people attain their highest level of health. Bolstering public health messaging about the lesser-known risk of liver disease as a complication of alcohol use and metabolic disease is also critical to helping people make informed decisions. Furthermore, stigma around both weight and alcohol use can discourage people from seeking care in the first place. Fewer than 10% of people with an alcohol use disorder receive treatment, and just 5% are prescribed evidence-based medications that have been demonstrated to reduce alcohol use. Clinicians can be a part of the solution by ensuring they are offering patients standard treatments for alcohol use disorder.”
Access to care remains a major challenge, particularly for those without adequate insurance or financial resources.
“Health care affordability and access to care are major barriers to timely diagnosis and treatment of alcohol- and metabolic-related health issues, particularly for people who are uninsured. Preventing progression to advanced liver disease isn’t just better for patients, it’s far less expensive than treating cirrhosis and its complications. In the U.S., we spend an estimated $135 billion on liver disease every year. We need prevention-focused approaches and more equitable access to care for the populations at highest risk.”
These findings reinforce the importance of prevention-focused policy and equitable healthcare access.
Priorities for future research
Looking ahead, the study highlights several important areas for further investigation.
“We should figure out how to intervene earlier, when obesity and risky alcohol use first begin to overlap, long before advanced liver disease develops. We also need more data on how existing treatments work in patients with multiple, co-occurring risk factors, since many clinical trials have historically excluded these groups.”
There is also a need to better understand how health systems and policy decisions shape outcomes.
“From a policy standpoint, future research should also look at how insurance coverage and access barriers affect outcomes for people at greatest risk. Better evidence in these areas could help guide more effective and equitable prevention strategies.”
A shift towards earlier, integrated prevention
Taken together, the findings point to a clear conclusion: the intersection of heavy alcohol use and obesity represents a growing and under-recognised driver of liver disease. Identifying and addressing these risks earlier, and in combination, may offer a meaningful opportunity to improve patient outcomes and reduce the long-term burden on healthcare systems.
Source: UPMC Life Changing Medicine
Parental Weight Before Pregnancy Linked to Higher Risk of Fatty Liver Disease in Adult Offspring, UK Study Finds
Key Takeaways:
- Pre-pregnancy overweight or obesity in either parent is associated with a significantly increased risk of metabolic dysfunction associated steatotic liver disease (MASLD) in their children by early adulthood.
- When both parents were living with overweight or obesity prior to conception, the likelihood of MASLD in offspring by age 24 was more than three times higher.
- Much of this increased risk appears to be mediated by excess weight accumulated during childhood and adolescence.
Rising concern over MASLD across generations
Parental weight status before pregnancy may play an important role in shaping long-term liver and metabolic health in the next generation, according to new research published online in Gut. The findings suggest that overweight and obesity in both mothers and fathers prior to conception are linked to a heightened risk of metabolic dysfunction associated steatotic liver disease (MASLD) in their children as young adults.
MASLD, previously known as non-alcoholic fatty liver disease, is now recognised as the most common chronic liver condition worldwide. Researchers note that the disease affects approximately 15% of children and more than 30% of adults globally. The condition is characterised by excess fat accumulation in the liver alongside cardiometabolic abnormalities and may progress to cirrhosis or liver failure in some individuals.
While earlier studies have primarily focused on maternal obesity, uncertainty has remained regarding the contribution of paternal weight and the role of childhood weight trajectories in determining future disease risk.
Large UK birth cohort provides long-term insight
To investigate these questions, researchers analysed data from 1,933 participants enrolled in the UK Avon Longitudinal Study of Parents and Children (ALSPAC), a long-running population study tracking health outcomes across generations.
The study examined associations between parental body mass index (BMI) before pregnancy and the likelihood that offspring would develop MASLD by the age of 24.
MASLD was defined as the presence of elevated liver fat together with at least one cardiometabolic risk factor, such as raised cholesterol levels or elevated fasting glucose.
Both parents provided information on height, weight, BMI and waist circumference before pregnancy. They also completed detailed questionnaires during pregnancy and following childbirth covering a wide range of potential influencing factors, including:
- Age at delivery
- Smoking during early pregnancy
- Weekly alcohol consumption prior to pregnancy
- Employment status
- Educational attainment
Mothers additionally reported physical activity levels and whether they had previously been diagnosed with diabetes or hypertension at study enrolment.
Tracking early life and adolescent risk factors
Extensive information was also collected about the children, allowing researchers to examine developmental influences across childhood and adolescence. Recorded factors included:
- Sex
- Mode of delivery
- Gestational age and birthweight
- Antibiotic exposure during the first six months of life
- Duration of breastfeeding
Participants underwent repeated measurements of BMI and waist circumference between the ages of 7–9, 10–12 and 13–17 years. Lifestyle factors in early adulthood, including alcohol and tobacco use, were also assessed.
One in ten young adults developed MASLD
By age 24, MASLD was identified in 201 participants, representing approximately one in ten individuals in the cohort. The remaining 1,732 participants had normal liver findings.
Those living with MASLD were more likely to be male and to have a higher BMI compared with peers without the condition.
After adjusting for multiple potential confounding factors, both maternal and paternal overweight or obesity before conception were independently associated with increased odds of MASLD in offspring.
Each additional kilogram per square metre of maternal BMI increased the likelihood of MASLD by 10%, while each equivalent increase in paternal BMI was associated with a 9% rise in risk.
Most notably, offspring whose parents were both living with overweight or obesity prior to pregnancy had more than three times the odds of developing MASLD compared with those whose parents had a normal BMI.
Childhood weight plays a central role
Further analysis suggested that much of this association operates through weight gain during childhood and adolescence. Researchers estimated that 67% of the increased risk linked to parental overweight or obesity was explained by cumulative excess BMI between the ages of 7 and 17.
Additional analyses incorporating maternal and offspring sugar intake, as well as genetic susceptibility to MASLD, produced similar results, strengthening confidence in the observed associations.
Observational findings with important limitations
The authors emphasise that the study was observational and therefore cannot establish direct causation. Several limitations were also acknowledged.
Parental weight data prior to pregnancy were self-reported, and information was unavailable regarding parental MASLD status or certain underlying health conditions before and during pregnancy. In addition, physical activity levels of offspring in early adulthood were not captured, which may have influenced outcomes.
Implications for preconception health
Despite these limitations, the researchers conclude that their findings highlight the potential importance of parental metabolic health before conception in shaping long-term outcomes for future generations.
They state that the results “lend support to an early life influence of biparental obesity on offspring metabolic health, suggesting efforts to mitigate excess adiposity of both mothers and fathers before conceiving may confer longitudinal benefits to the metabolic outcomes of their future offspring.“
The study adds to growing evidence that prevention of metabolic disease may need to begin not only in childhood, but even before pregnancy, with both parents playing a meaningful role in influencing lifelong health trajectories.
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