Association Between Ultra-Processed Food Consumption and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Adults
A Systematic Review
DOI:
https://doi.org/10.55606/ijmh.v5i3.6394Keywords:
Diet, Hepatic Steatosis, MASLD, Ultra-Processed Food, Systematic ReviewAbstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease globally, but its association with ultra-processed food (UPF) consumption under the new diagnostic framework has not been systematically synthesized. We systematically searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science for observational studies examining habitual UPF intake (NOVA classification) and MASLD/NAFLD in general adult populations using validated outcome ascertainment. Quality was appraised via the Newcastle-Ottawa Scale (NOS) and certainty via GRADE. Eight studies comprising >350,000 adults across six countries met the eligibility criteria, with seven rated as good methodological quality. All eight studies reported a positive association between higher UPF consumption and MASLD risk, with prospective adjusted hazard ratios ranging from 1.18 to 1.50 and cross-sectional odds ratios from 1.33 to 2.50. Additionally, decreasing UPF intake significantly lowered intrahepatic fat (7.7% to 2.6%), and an exposure-response gradient was observed across several cohorts. Approximately two-thirds of the association was mediated by adiposity (attenuated after BMI adjustment), while evidence for hepatic fibrosis remained inconsistent. GRADE certainty was rated as Low for the primary association and exposure-response gradient, and Very Low for intrahepatic fat and fibrosis outcomes. In conclusion, higher habitual UPF intake is consistently associated with an increased burden of MASLD in adults, largely mediated by adiposity. Although observational nature limits direct causality, these findings support restricting UPF consumption while awaiting further prospective studies using explicit MASLD criteria.
References
Baharuddin, B. (2025). The metabolic and molecular mechanisms linking fructose consumption to lipogenesis and metabolic disorders. Clinical Nutrition ESPEN, 69, 63–68. https://doi.org/10.1016/j.clnesp.2025.06.042
Barbaresko, J., Broder, J., Conrad, J., Szczerba, E., Lang, A., & Schlesinger, S. (2024). Ultra-processed food consumption and human health: An umbrella review of systematic reviews with meta-analyses. Critical Reviews in Food Science and Nutrition, 65(11), 1999–2007. https://doi.org/10.1080/10408398.2024.2317877
Callans, L. E., Ivey, K. L., Chang, K. M., & Kaplan, D. E. (2025). Diet composition impacts the natural history of steatotic liver disease. Hepatology Communications, 9(7), e0754. https://doi.org/10.1097/HC9.0000000000000754
Canhada, S. L., Vigo, A., Giatti, L., Fonseca, M. J., Lopes, L. J., Cardoso, L. O., et al. (2024). Associations of ultra-processed food intake with the incidence of cardiometabolic and mental health outcomes go beyond specific subgroups - the Brazilian Longitudinal Study of Adult Health. Nutrients, 16(24), 4291. https://doi.org/10.3390/nu16244291
Chamarthi, V. S., Shirsat, P., Sonavane, K., Parsi, S., Ravi, U., Ponnam, H. C., et al. (2025). The impact of ultra-processed foods on pediatric health. Obesity Pillars, 16, 100203. https://doi.org/10.1016/j.obpill.2025.100203
Donghia, R., Pesole, P. L., Coletta, S., Bonfiglio, C., De Pergola, G., De Nucci, S., et al. (2023). Food network analysis in non-obese patients with or without steatosis. Nutrients, 15(12), 2713. https://doi.org/10.3390/nu15122713
Garcia, S., Monserrat-Mesquida, M., Ugarriza, L., Casares, M., Gomez, C., Mateos, D., et al. (2025). Ultra-processed food consumption and metabolic-dysfunction-associated steatotic liver disease (MASLD): A longitudinal and sustainable analysis. Nutrients, 17(3), 472. https://doi.org/10.3390/nu17030472
Grinshpan, L. S., Eilat-Adar, S., Ivancovsky-Wajcman, D., Kariv, R., Gillon-Keren, M., & Zelber-Sagi, S. (2023). Ultra-processed food consumption and non-alcoholic fatty liver disease, metabolic syndrome and insulin resistance: A systematic review. JHEP Reports, 6(1), 100964. https://doi.org/10.1016/j.jhepr.2023.100964
Guo, C., Yang, W. C., Zhou, J., Wang, J. J., & Ji, D. (2025). Ultra-processed food intake and risk of adverse liver outcomes: A meta-analysis. Journal of Food Science, 90(6), e70303. https://doi.org/10.1111/1750-3841.70303
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., et al. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336(7650), 924–926. https://doi.org/10.1136/bmj.39489.470347.AD
Henney, A. E., Gillespie, C. S., Alam, U., Hydes, T. J., & Cuthbertson, D. J. (2023). Ultra-processed food intake is associated with non-alcoholic fatty liver disease in adults: A systematic review and meta-analysis. Nutrients, 15(10), 2266. https://doi.org/10.3390/nu15102266
Ivancovsky-Wajcman, D., Fliss-Isakov, N., Webb, M., Bentov, I., Shibolet, O., Kariv, R., et al. (2021). Ultra-processed food is associated with features of metabolic syndrome and non-alcoholic fatty liver disease. Liver International, 41(11), 2635–2645. https://doi.org/10.1111/liv.14996
Kaenkumchorn, T. K., Merritt, M. A., Lim, U., Le Marchand, L., Boushey, C. J., Shepherd, J. A., et al. (2021). Diet and liver adiposity in older adults: The Multiethnic Cohort Adiposity Phenotype Study. The Journal of Nutrition, 151(11), 3579–3587. https://doi.org/10.1093/jn/nxab300
Kwon, Y. J., Lee, H. S., & Lee, J. W. (2025). Association between dietary patterns and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease. Endocrine, 90(2), 558–569. https://doi.org/10.1007/s12020-025-04365-x
Lee, G. Y., Lim, J. H., Joung, H., & Yoon, D. (2024). Association between ultraprocessed food consumption and metabolic disorders in children and adolescents with obesity. Nutrients, 16(20), 3524. https://doi.org/10.3390/nu16203524
Marjot, T., Tomlinson, J. W., Hodson, L., & Ray, D. W. (2023). Timing of energy intake and the therapeutic potential of intermittent fasting and time-restricted eating in NAFLD. Gut, 72(8), 1607–1619. https://doi.org/10.1136/gutjnl-2023-329998
Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J. C., Louzada, M. L., Rauber, F., et al. (2019). Ultra-processed foods: What they are and how to identify them. Public Health Nutrition, 22(5), 936–941. https://doi.org/10.1017/S1368980018003762
Mozes, F. E., Lee, J. A., Selvaraj, E. A., Jayaswal, A. N. A., Trauner, M., Boursier, J., et al. (2022). Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: An individual patient data meta-analysis. Gut, 71(5), 1006–1019. https://doi.org/10.1136/gutjnl-2021-324243
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Rahimi-Sakak, F., Maroofi, M., Emamat, H., & Hekmatdoost, A. (2022). Red and processed meat intake in relation to non-alcoholic fatty liver disease risk: Results from a case-control study. Clinical Nutrition Research, 11(1), 42–49. https://doi.org/10.7762/cnr.2022.11.1.42
Rinella, M. E., Lazarus, J. V., Ratziu, V., Francque, S. M., Sanyal, A. J., Kanwal, F., et al. (2023). A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Journal of Hepatology, 79(6), 1542–1556. https://doi.org/10.1016/j.jhep.2023.06.003
Silva-Luis, C. C., Lopes, M. S., Gomes, S. M., Cantalice Matias, P. K., Brandini, F. P., Costa, P. C. T., et al. (2024). Ultra-processed food consumption and cardiometabolic risk factors in children living in Northeastern Brazil. Nutrients, 16(22), 3944. https://doi.org/10.3390/nu16223944
Stang, A. (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology, 25(9), 603–605. https://doi.org/10.1007/s10654-010-9491-z
Sun, N., Prescott, B., Ma, J., Xanthakis, V., Quatromoni, P. A., Long, M. T., et al. (2025). The cross-sectional association between ultra-processed food intake and metabolic dysfunction-associated steatotic liver disease. Clinical Nutrition ESPEN, 66, 215–220. https://doi.org/10.1016/j.clnesp.2025.01.045
Tutunchi, H., Saghafi-Asl, M., Asghari-Jafarabadi, M., & Ostadrahimi, A. (2021). Association between dietary patterns and non-alcoholic fatty liver disease: Results from a case-control study. Archives of Iranian Medicine, 24(1), 35–42. https://doi.org/10.34172/aim.2021.06
Yaskolka Meir, A., Rinott, E., Tsaban, G., Zelicha, H., Kaplan, A., Rosen, P., et al. (2021). Effect of green-Mediterranean diet on intrahepatic fat: The DIRECT PLUS randomised controlled trial. Gut, 70(11), 2085–2095. https://doi.org/10.1136/gutjnl-2020-323106
Younossi, Z. M., Golabi, P., Price, J. K., Owrangi, S., Gundu-Rao, N., Satchi, R., et al. (2024). The global epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among patients with type 2 diabetes. Clinical Gastroenterology and Hepatology, 22(10), 1999–2010. https://doi.org/10.1016/j.cgh.2024.03.006
Zeng, X. F., Varady, K. A., Wang, X. D., Targher, G., Byrne, C. D., Tayyem, R., et al. (2024). The role of dietary modification in the prevention and management of metabolic dysfunction-associated fatty liver disease: An international multidisciplinary expert consensus. Metabolism, 161, 156028. https://doi.org/10.1016/j.metabol.2024.156028
Zhang, J., Shu, L., & Chen, X. (2025). Ultra-processed foods and non-alcoholic fatty liver disease: An updated systematic review and dose-response meta-analysis. Frontiers in Nutrition, 12, 1631975. https://doi.org/10.3389/fnut.2025.1631975
Zhang, S., Gan, S., Zhang, Q., Liu, L., Meng, G., Yao, Z., et al. (2022). Ultra-processed food consumption and the risk of non-alcoholic fatty liver disease in the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. International Journal of Epidemiology, 51(1), 237–249. https://doi.org/10.1093/ije/dyab174
Zhang, Y. F., Qiao, W., Zhuang, J., Feng, H., Zhang, Z., & Zhang, Y. (2024). Association of ultra-processed food intake with severe non-alcoholic fatty liver disease: A prospective study of 143073 UK Biobank participants. Journal of Nutrition, Health & Aging, 28(10), 100352. https://doi.org/10.1016/j.jnha.2024.100352
Zhao, L., Chen, Y., Clay-Gilmour, A., Zhang, J., Zhang, X., & Steck, S. E. (2025). Metabolomic and proteomic signatures of ultra-processed foods are positively associated with adverse liver outcomes. The Journal of Nutrition, 155(6), 1851–1858. https://doi.org/10.1016/j.tjnut.2025.04.034
Zhao, L., Clay-Gilmour, A., Zhang, J., Zhang, X., & Steck, S. E. (2023). Higher ultra-processed food intake is associated with adverse liver outcomes: A prospective cohort study of UK Biobank participants. The American Journal of Clinical Nutrition, 119(1), 49–57. https://doi.org/10.1016/j.ajcnut.2023.10.014
Zhao, L., Zhang, X., Martinez Steele, E., Lo, C. H., Zhang, F. F., & Zhang, X. (2023). Higher ultra-processed food intake was positively associated with odds of NAFLD in both US adolescents and adults: A national survey. Hepatology Communications, 7(9), e0240. https://doi.org/10.1097/HC9.0000000000000240
Zheng, J., Zhao, L., Dong, J., Chen, H., Li, D., Zhang, X., et al. (2022). The role of dietary factors in nonalcoholic fatty liver disease to hepatocellular carcinoma progression: A systematic review. Clinical Nutrition, 41(10), 2295–2307. https://doi.org/10.1016/j.clnu.2022.08.018
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 International Journal of Medicine and Health
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
