A diet designed to be healthy for both people and the planet is also linked to a lower risk of metabolic dysfunction-associated steatotic liver disease (MASLD), a condition marked by fat accumulation in the liver, according to an analysis of more than 100,000 UK adults published in The Innovation Nutrition.
In 2025, the second EAT-Lancet Commission updated the Planetary Health Diet (PHD 2.0), a framework that emphasizes plant-based foods while limiting animal-source foods, saturated fat, sugar and sodium. Whether following this updated diet relates to MASLD risk was largely unknown.
A team led by corresponding authors Tao Huang (Peking University) and Shunming Zhang (Xi'an Jiaotong University) analyzed 107,940 UK Biobank participants who completed at least two 24-hour dietary assessments. Adherence to PHD 2.0 was scored with two indices: the EAT-Lancet index 2.0 (0–45 points) and a modified Planetary Health Diet Index (0–150 points). New MASLD cases were identified through electronic health records over a median follow-up of 10.5 years, during which 775 participants developed MASLD. The team also used magnetic resonance imaging to measure liver fat (proton density fat fraction, n = 16,770) and fibroinflammation, defined by elevated iron-corrected T1 (n = 14,015).
Participants in the highest adherence quartile had a substantially lower risk of developing MASLD than those in the lowest. Risk declined stepwise across quartiles: hazard ratios of 0.86, 0.81 and 0.66 (95% CI 0.53–0.82) across increasing quartiles of the EAT-Lancet index 2.0, and 0.84, 0.80 and 0.61 (0.49–0.77) for the modified Planetary Health Diet Index — equivalent to roughly 34–39% lower risk at the top, with significant dose–response trends (P < 0.0001). MRI told a consistent story: comparing extreme quartiles, higher adherence was associated with lower liver fat (odds ratios 0.56 and 0.59) and lower odds of elevated iron-corrected T1 (0.63 and 0.61).
The authors conclude that greater adherence to PHD 2.0 is associated with decreased MASLD risk and favorable imaging biomarkers, extending the evidence base for the updated planetary health diet beyond cardiometabolic outcomes. As an observational cohort study, it cannot prove causation; diet was self-reported, and the findings come from a predominantly middle-aged and older UK population. If confirmed in other cohorts and populations, the results suggest that a diet chosen for planetary health may also benefit the liver.
