{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:16:06Z","timestamp":1789827366162,"version":"4.0.1"},"reference-count":48,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health Ricerca Corrente 2025","doi-asserted-by":"publisher","award":["Ricerca Corrente 2025"],"award-info":[{"award-number":["Ricerca Corrente 2025"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Previous studies have shown a relationship between Visceral Adipose Tissue (VAT) and Hepatic Fat Content (HFC), and increases in HFC are linked to metabolic abnormalities similar to those associated with elevated VAT. Several short-term and long-term studies have supported these findings. Lifestyle interventions remain the cornerstone of treatment for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), although the ideal dietary regimen is still under debate. Methods: Data on 2040 patients were extracted from the Clinical Nutrition Unit database between 2017 and 2019. Of these, 474 subjects with MASLD and Body Mass Index (BMI) \u2265 35 kg\/m2 were treated with a four-month low-carbohydrate dietary intervention called the \u201cStrong Diet\u201d (StD). VAT and liver stiffness were measured at baseline and after four months of treatment using ultrasound. Results: Our study demonstrates the significant efficacy of StD in reducing VAT in MASLD patients with moderate hepatic steatosis. In subjects with severe steatosis, there is no statistically significant response to dietary intervention. This may be attributed to several irreversible molecular mechanisms that fundamentally alter the hepatic microenvironment and limit the liver\u2019s capacity for regeneration and metabolic recovery. Conclusions: Improvements were largely confined to patients with moderate MASLD, with limited benefit in severe disease. Although dietary intervention remains the cornerstone of MASLD management, patients with severe steatosis should be informed about the potential limited resolution of steatosis, even with optimal metabolic control.<\/jats:p>","DOI":"10.3390\/nu17172905","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T08:40:15Z","timestamp":1757407215000},"page":"2905","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Effect of a Four-Month Low-Carbohydrate Diet on Visceral Adipose Tissue in Obese Subjects with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)"],"prefix":"10.3390","volume":"17","author":[{"given":"Ornella","family":"Rotolo","sequence":"first","affiliation":[{"name":"Clinical Trial Unit, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, Castellana Grotte, 70013 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8650-348X","authenticated-orcid":false,"given":"Caterina","family":"Bonfiglio","sequence":"additional","affiliation":[{"name":"Unit of Data Science, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, Castellana Grotte, 70013 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Reddavide","sequence":"additional","affiliation":[{"name":"Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, Castellana Grotte, 70013 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5647-8009","authenticated-orcid":false,"given":"Anna Maria","family":"Cisternino","sequence":"additional","affiliation":[{"name":"Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, Castellana Grotte, 70013 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Inguaggiato","sequence":"additional","affiliation":[{"name":"Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, Castellana Grotte, 70013 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-8060","authenticated-orcid":false,"given":"Gianluigi","family":"Giannelli","sequence":"additional","affiliation":[{"name":"Scientific Direction, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, Castellana Grotte, 70013 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/j.jhep.2017.07.027","article-title":"Fibrosis Stage but Not NASH Predicts Mortality and Time to Development of Severe Liver Disease in Biopsy-Proven NAFLD","volume":"67","author":"Nasr","year":"2017","journal-title":"J. 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