Metabolic dysfunction-associated liver disease (MASLD) is defined by hepatic steatosis (fat accumulation in the liver) in the presence of at least one cardiometabolic risk factor such as obesity or hypertension. Diet and lifestyle modifications are primary management strategies for MASLD, and investigators have sought to identify specific foods that could influence liver fat.
A recent exploratory randomized controlled trial published in Nutrients evaluated whether regular tomato consumption could affect hepatic fat in adults with MASLD. Tomatoes are a common component of the Mediterranean diet and contain compounds, including carotenoids and lycopene, that have been proposed to exert metabolic and antioxidant effects.
The trial enrolled 79 adults diagnosed with MASLD. The investigators excluded certain groups, including people who consumed above-specified amounts of alcohol and individuals with a body mass index (BMI) over 30 kg/m²; most participants were men, and the sample included adults aged up to 65 years.
Participants were randomized to one of two arms. The control group followed a tomato-free diet, while the intervention group consumed 200 grams of raw tomatoes plus 50 grams of tomato sauce daily. All tomato products provided in the study came from the same producer. The dietary intervention lasted for 6 weeks. Outside of the provided tomato dose for the intervention arm, participants were instructed to continue their usual lifestyles.
Outcomes assessed before and after the intervention included body composition, imaging-based measures of hepatic steatosis, liver stiffness, cholesterol and lipid measures, liver enzymes, insulin resistance markers, inflammatory markers, and body mass index.
Over the 6-week period, hepatic steatosis declined in both study groups, but the reduction was greater in the tomato intervention group compared with the tomato-free control group. Baseline levels of hepatic steatosis were similar between groups.
No substantial differences between groups emerged for liver stiffness, biochemical liver tests (liver enzymes), lipid profiles, insulin resistance markers, inflammatory markers, or body composition measures including BMI after the intervention period.
The study authors concluded that the results suggest tomato consumption may reduce hepatic fat accumulation independently of major changes in body weight or total and abdominal adiposity, though they framed the work as exploratory.
Several limitations restrict the conclusions that can be drawn from this trial. The intervention lasted only 6 weeks, so long-term effects and sustainability are unknown. The study excluded participants with BMI over 30 kg/m², which limits applicability to the many MASLD patients who have obesity. Most participants were men and all were 65 years or younger, so findings may not generalize across sexes or to older adults.
Adherence assessment relied on dietary counseling and participant self-report, which can introduce reporting bias. The intervention combined raw tomatoes and tomato sauce, so the trial cannot distinguish whether one form, the combination, or specific constituents (for example, lycopene or other carotenoids) drove the observed change.
The investigators did not measure circulating levels of lycopene or other carotenoids, so biologic mediators of any effect were not assessed.
External clinicians quoted in the article emphasized these limitations. An endocrinologist noted the population was highly selected and that most clinical patients have obesity, type 2 diabetes, or more advanced metabolic disease, reducing generalizability. Another clinician raised concern that the trial treated cardiometabolic risk factors as equivalent, though risk conferred by type 2 diabetes differs from that of isolated hypertension.
The authors described the study as exploratory and hypothesis-generating rather than definitive. While imaging showed reduced hepatic fat with the tomato intervention, there were no significant improvements in clinically relevant markers such as liver stiffness, fibrosis scores, liver enzymes, insulin resistance, inflammatory markers, lipid profiles, or body composition over the 6-week period.
Because clinically meaningful disease progression and outcomes were not improved in this short trial, the findings do not support a change in MASLD treatment recommendations. Clinicians quoted in the article advised caution about translating these results into practice until larger and longer trials confirm the effect and link it to meaningful outcomes.
The trial suggests a potential, modest benefit of tomato consumption for reducing hepatic fat in a selected MASLD population, and it may help inform future research questions about dietary components and liver health. Tomatoes contain nutrients and bioactive compounds with plausibly beneficial properties, and prior literature has proposed cardiovascular and other health benefits for tomato-rich diets.
However, clinicians emphasized that dietary interventions must be considered within the broader context of treating underlying metabolic disease. For patients with obesity, sustained weight loss of roughly 10% or more has the most robust evidence for improving steatohepatitis and fibrosis. The study authors and external experts therefore recommend viewing tomato intake as one element of a broader dietary pattern rather than a standalone therapy.
Practical considerations include potential adverse effects of tomato-based foods for some patients (for example, exacerbation of gastroesophageal reflux disease) and the variable caloric density of tomato-containing preparations, which may affect insulin resistance in some individuals.
In summary, this small, short-duration randomized trial reported a greater reduction in imaging-measured hepatic steatosis among adults with MASLD who ate raw tomatoes and tomato sauce daily compared with a tomato-free control. The evidence is preliminary; further research with larger, more diverse populations, longer follow-up, objective measures of tomato-related bioactives (such as circulating lycopene), and clinically meaningful endpoints is needed before changing clinical practice.