{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:36:27Z","timestamp":1785411387011,"version":"3.56.0"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015550","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["Ricerca Corrente 2026"],"award-info":[{"award-number":["Ricerca Corrente 2026"]}],"id":[{"id":"10.13039\/501100015550","id-type":"DOI","asserted-by":"publisher"}]},{"award":["Ricerca Corrente 2026"],"award-info":[{"award-number":["Ricerca Corrente 2026"]}],"id":[{"id":"https:\/\/ror.org\/00789fa95","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with obesity, insulin resistance, and altered body composition. Although dietary intervention is a cornerstone of treatment, complex or calorie-restricted regimens may reduce long-term adherence. This study evaluated the effects of a pragmatic, short-term intervention that involved replacing one daily carbohydrate serving with cruciferous vegetables on body composition and metabolic parameters in individuals with obesity and MASLD. Associations between changes in fat mass and vitamin D and follistatin levels were also explored. Methods: In this prospective pilot study, 44 adults with obesity and MASLD followed a two-month intervention, substituting one daily serving of carbohydrate-rich foods with 200 g of cruciferous vegetables, without prescribed caloric restriction. Anthropometric, bioimpedance, biochemical, and FibroScan assessments were performed at baseline and post-intervention. Changes were analyzed using the Wilcoxon signed-rank test, Spearman\u2019s correlation analysis, and generalized estimating equation (GEE) models adjusted for confounding factors. Results: The intervention was associated with a significant reduction in fat mass (\u22124.86 kg, p &lt; 0.001), corresponding to an average relative decrease of approximately 12% along with improvements in metabolic and hepatic parameters. Changes in fat mass were inversely correlated with changes in vitamin D (rho = \u22120.33, p = 0.035), fat-free mass (rho = \u22120.37, p = 0.018), and follistatin (rho = \u22120.24, p = 0.143). In multivariate GEE models, the intervention remained independently associated with fat mass reduction (\u03b2 = \u22125.190, p &lt; 0.001). Conclusions: A simple carbohydrate-to-vegetable substitution without prescribed caloric restriction was associated with improvements in body composition and metabolic health. These exploratory findings suggest that pragmatic dietary modifications may provide clinically meaningful metabolic benefits and support the feasibility of minimal dietary substitution strategies in this population. However, causal inferences remain limited by a single-arm pilot design and require confirmation in larger randomized controlled trials.<\/jats:p>","DOI":"10.3390\/nu18121873","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:48:35Z","timestamp":1781138915000},"page":"1873","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Single-Food Substitution Strategy (SFSS) Improves Fat Mass and Metabolic Parameters in MASLD: A Prospective Pilot Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Nicole","family":"Cerabino","sequence":"first","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, 70013 Castellana Grotte, 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, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonilde","family":"Bonfrate","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, 70013 Castellana Grotte, Bari, Italy"},{"name":"Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Rome University, 00166 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanna","family":"Donvito","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, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4675-2075","authenticated-orcid":false,"given":"Pasqua Letizia","family":"Pesole","sequence":"additional","affiliation":[{"name":"Core Facility Biobank, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Stabile","sequence":"additional","affiliation":[{"name":"Core Facility Biobank, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4909-0436","authenticated-orcid":false,"given":"Endrit","family":"Shahini","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, 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, 70013 Castellana Grotte, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1053\/j.gastro.2019.11.312","article-title":"MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease","volume":"158","author":"Eslam","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.3350\/cmh.2024.0431","article-title":"Epidemiology of metabolic dysfunction-associated steatotic liver disease","volume":"31","author":"Younossi","year":"2025","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1038\/s41591-018-0104-9","article-title":"Mechanisms of NAFLD development and therapeutic strategies","volume":"24","author":"Friedman","year":"2018","journal-title":"Nat. Med."},{"key":"ref_4","first-page":"955","article-title":"Guideline for the Prevention and Treatment of Metabolic Dysfunction-associated Fatty Liver Disease (Version 2024)","volume":"12","author":"Fan","year":"2024","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_5","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2024). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J. Hepatol., 81, 492\u2013542."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1053\/j.gastro.2015.04.005","article-title":"Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis","volume":"149","author":"Friedman","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e212","DOI":"10.1002\/mco2.212","article-title":"Dietary patterns and cardiometabolic health: Clinical evidence and mechanism","volume":"4","author":"Wang","year":"2023","journal-title":"MedComm"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jurek, J.M., Zablocka-Slowinska, K., Pieczynska, J., Clavero Mestres, H., and Auguet, T. (2025). Systematic Review of the Effects of Plant-Based Foods on Metabolic Outcomes in Adults with MASLD and Comorbidities Such as Obesity, Metabolic Syndrome, and Type 2 Diabetes. Nutrients, 17.","DOI":"10.3390\/nu17183020"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13772","DOI":"10.1038\/s41598-022-17969-4","article-title":"Association between plant-based diets and metabolic health status in adolescents with overweight and obesity","volume":"12","author":"Mokhtari","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.phrs.2007.01.009","article-title":"Cruciferous vegetables and human cancer risk: Epidemiologic evidence and mechanistic basis","volume":"55","author":"Higdon","year":"2007","journal-title":"Pharmacol. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.phrs.2011.07.005","article-title":"Bioavailability and inter-conversion of sulforaphane and erucin in human subjects consuming broccoli sprouts or broccoli supplement in a cross-over study design","volume":"64","author":"Clarke","year":"2011","journal-title":"Pharmacol. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/15598276231167778","article-title":"The Importance of Dietary Fiber for Metabolic Health","volume":"17","author":"Bulsiewicz","year":"2023","journal-title":"Am. J. Lifestyle Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Maffetone, P., and Laursen, P.B. (2025). Refined carbohydrates and the overfat pandemic: Implications for brain health and public health policy. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1585680"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Reynolds, A.N., Akerman, A., Kumar, S., Diep Pham, H.T., Coffey, S., and Mann, J. (2022). Dietary fibre in hypertension and cardiovascular disease management: Systematic review and meta-analyses. BMC Med., 20.","DOI":"10.1186\/s12916-022-02328-x"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wimalawansa, S.J. (2023). Physiological Basis for Using Vitamin D to Improve Health. Biomedicines, 11, Erratum in Biomedicines 2024, 12, 2807.","DOI":"10.3390\/biomedicines12122807"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Aggeletopoulou, I., Tsounis, E.P., and Triantos, C. (2024). Vitamin D and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Novel Mechanistic Insights. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25094901"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Dai, D., Ling, Y., Xu, F., Li, H., Wang, R., Gu, Y., Xia, X., Xiong, A., Sun, R., and Qiu, L. (2025). Impact of body composition on vitamin D requirements in healthy adults with vitamin D deficiency. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1421663"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"106785","DOI":"10.1016\/j.prostaglandins.2023.106785","article-title":"Follistatin and follistatin-like 3 in metabolic disorders","volume":"169","author":"Bielka","year":"2023","journal-title":"Prostaglandins Other Lipid Mediat."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cerabino, N., Bonfiglio, C., Di Chito, M., Donvito, R., Mongelli, F.P., Pesole, P.L., Stabile, D., Shahini, E., Zappimbulso, M., and Cozzolongo, R. (2025). Association Between Follistatin and PAI-1 Levels in MASLD Subjects Undergoing a Plant-Based Dietary Intervention. Nutrients, 17.","DOI":"10.3390\/nu17132124"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jshs.2019.03.007","article-title":"New scientific basis for the 2018 U.S. Physical Activity Guidelines","volume":"8","author":"DiPietro","year":"2019","journal-title":"J. Sport Health Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.numecd.2008.10.007","article-title":"Adherence to the Mediterranean diet and risk of metabolic syndrome and its components","volume":"19","author":"Babio","year":"2016","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"De Nucci, S., Rinaldi, R., Di Chito, M., Donghia, R., Giannuzzi, V., Shahini, E., Cozzolongo, R., Pesole, P.L., Coletta, S., and De Pergola, G. (2023). The Replacement of Only One Portion of Starchy Carbohydrates with Green Leafy Vegetables Regresses Mid and Advanced Stages of NAFLD: Results from a Prospective Pilot Study. Nutrients, 15.","DOI":"10.3390\/nu15102289"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"8348","DOI":"10.1039\/D2FO01488B","article-title":"Are isothiocyanates and polyphenols from Brassicaceae vegetables emerging as preventive\/therapeutic strategies for NAFLD? The landscape of recent preclinical findings","volume":"13","author":"Bacil","year":"2022","journal-title":"Food Funct."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1053\/j.gastro.2019.01.042","article-title":"Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients with Nonalcoholic Fatty Liver Disease","volume":"156","author":"Eddowes","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1016\/j.ultrasmedbio.2018.07.008","article-title":"Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations","volume":"44","author":"Ferraioli","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.clnesp.2019.09.012","article-title":"Equation models developed with bioelectric impedance analysis tools to assess muscle mass: A systematic review","volume":"35","author":"Beaudart","year":"2020","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1038\/s41430-018-0335-3","article-title":"Bioelectrical impedance analysis for body composition assessment: Reflections on accuracy, clinical utility, and standardization","volume":"73","author":"Ward","year":"2019","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e003680","DOI":"10.1136\/bmjdrc-2023-003680","article-title":"Should insulin resistance (HOMA-IR), insulin secretion (HOMA-\u03b2), and visceral fat area be considered for improving the performance of diabetes risk prediction models","volume":"12","author":"Hu","year":"2024","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/biomet\/73.1.13","article-title":"Longitudinal data analysis using generalized linear models","volume":"73","author":"Liang","year":"1986","journal-title":"Biometrika"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Hastie, T., Tibshirani, R., and Wainwright, M. (2015). Statistical Learning with Sparsity: The Lasso and Generalizations, Chapman and Hall\/CRC. [1st ed.].","DOI":"10.1201\/b18401"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/j.jada.2007.07.017","article-title":"Weight-loss outcomes: A systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up","volume":"107","author":"Franz","year":"2007","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1093\/ajcn\/84.3.475","article-title":"The underappreciated role of muscle in health and disease","volume":"84","author":"Wolfe","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1002\/hep.32689","article-title":"AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury","volume":"77","author":"Fontana","year":"2023","journal-title":"Hepatology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1111\/dom.14322","article-title":"Nonalcoholic fatty liver disease as a metabolic disease in humans: A literature review","volume":"23","author":"Cariou","year":"2021","journal-title":"Diabetes Obes. Metab."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"281S","DOI":"10.1093\/ajcn\/76.1.281S","article-title":"Glycemic index and obesity","volume":"76","author":"Holt","year":"2002","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"52","DOI":"10.3109\/10408363.2015.1084990","article-title":"Sugar consumption, metabolic disease and obesity: The state of the controversy","volume":"53","author":"Stanhope","year":"2016","journal-title":"Crit. Rev. Clin. Lab Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.nut.2004.08.018","article-title":"Dietary fiber and body weight","volume":"21","author":"Slavin","year":"2005","journal-title":"Nutrition"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1093\/ajcn\/nqx082","article-title":"Dietary fiber and health outcomes: An umbrella review of systematic reviews and meta-analyses","volume":"107","author":"Veronese","year":"2018","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_39","first-page":"173","article-title":"Cancer-preventive isothiocyanates: Measurement of human exposure and mechanism of action","volume":"555","author":"Zhang","year":"2004","journal-title":"Mutat. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1111\/j.1471-4159.2009.06394.x","article-title":"Sulforaphane as an inducer of glutathione prevents oxidative stress-induced cell death in a dopaminergic-like neuroblastoma cell line","volume":"111","author":"Tarozzi","year":"2009","journal-title":"J. Neurochem."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1111\/cas.12195","article-title":"Cruciferous vegetable consumption and gastric cancer risk: A meta-analysis of epidemiological studies","volume":"104","author":"Wu","year":"2013","journal-title":"Cancer Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1017\/S0029665114001578","article-title":"Vitamin D and obesity: Current perspectives and future directions","volume":"74","author":"Pourshahidi","year":"2015","journal-title":"Proc. Nutr. Soc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1038\/oby.2011.404","article-title":"Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity","volume":"20","author":"Drincic","year":"2012","journal-title":"Obesity"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/cen.12760","article-title":"Vitamin D and insulin resistance","volume":"84","author":"Wallace","year":"2016","journal-title":"Clin. Endocrinol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1210\/me.2010-0127","article-title":"Regulation of muscle mass by follistatin and activins","volume":"24","author":"Lee","year":"2010","journal-title":"Mol. Endocrinol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/dom.13572","article-title":"Follistatins in glucose regulation in healthy and obese individuals","volume":"21","author":"Perakakis","year":"2019","journal-title":"Diabetes Obes. Metab."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1873\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:56:48Z","timestamp":1781139408000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1873"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18121873"],"URL":"https:\/\/doi.org\/10.3390\/nu18121873","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]}}}