Culturally adapted multimodal lifestyle approaches for metabolic dysfunction-associated steatotic liver disease: role of diet, physical activity and sleep.

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver condition worldwide, affecting approximately 30% of the population globally. MASLD often coexists with hypertension, central obesity, type 2 diabetes and dyslipidaemia, yet globally, national treatment strategies are still being established. Pharmacological options are limited and lifestyle modification to achieve weight loss through combining diet, physical activity (PA) and structured exercise remains the cornerstone of MASLD management. The Mediterranean diet (MedDiet) is an evidence-based dietary approach for MASLD prevention and treatment; however, its application in culturally and linguistically diverse, non-Mediterranean populations requires adaptation. In fact, the need for cultural adaptation for all lifestyle interventions (diet, PA and sleep) needs better acknowledgement and implementation. There are limited interventions which combine all lifestyle behaviours and even fewer that consider cultural safety and appropriateness. Furthermore, limited healthcare staffing resources, geographical location and health system pressures highlight the need for more accessible and cost-effective delivery methods. This review summarises evidence on MedDiet for MASLD in multicultural populations, explores the synergistic benefits of combining with PA and sleep interventions and provides practical recommendations for culturally tailored approaches. Finally, we outline future directions for research and healthcare delivery, emphasising the urgent need for holistic, culturally safe, culturally responsive, efficient and digitally enabled strategies to address the growing global burden of MASLD.