Review synthesizes Resistant Starch's impact on MASLD, highlighting microbial ecology and response variability for precision nutrition.

Metabolic dysfunction-associated steatotic liver disease (MASLD) requires hepatic steatosis with cardiometabolic risk. Current management emphasizes diet, exercise, and weight loss, with emerging pharmacological options like resmetirom and semaglutide. However, nutritional adjuncts need evaluation for specific hepatic and metabolic outcomes. The gut microbiome significantly influences hepatic metabolism, offering a route for dietary interventions. Resistant starch (RS), a dietary fiber fermented in the colon, is being studied for its potential to modulate the microbiome and impact host physiology, addressing gaps in personalized MASLD nutrition.

This paper is a comprehensive review synthesizing current research on Resistant Starch (RS) in the context of MASLD. It examines the intricate relationships between RS, gut microbial ecology, and heterogeneous host responses. The review aims to identify factors contributing to variable clinical outcomes and to outline a path towards precision nutrition strategies for MASLD patients, integrating insights from diverse studies on RS types and their metabolic effects, and considering its prebiotic designation.

This review synthesizes the existing evidence on Resistant Starch (RS), highlighting its potential to influence MASLD progression through gut microbiome modulation. It identifies that while RS generally shows promise for improving insulin sensitivity, lipid profiles, and inflammatory markers, clinical outcomes are often inconsistent. This variability is attributed to factors like the specific RS type, dosage, and individual differences in gut microbial composition and host metabolic responses. The paper emphasizes the need to understand these heterogeneous responses to move towards personalized nutritional strategies.

The review underscores that despite widespread investigation into RS, a clear, consistent protocol for its application in MASLD is lacking due to significant inter-individual variability and differences across study designs. It points to the critical role of microbial ecology in mediating RS effects, suggesting that tailoring RS interventions based on an individual's microbiome profile could optimize therapeutic benefits for hepatic and cardiometabolic health.