Jigyasa Sharma, Kathleen Viveiros
ABSTRACT Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is projected to affect more than 40% of adults by 2050. Although pharmacologic therapies are emerging, lifestyle modification remains the foundation of management. Yet, application of lifestyle modification lags behind existing data. We performed a narrative review of the literature on lifestyle interventions for MASLD, organized around the American College of Lifestyle Medicine's six evidence‐based pillars: nutrition, physical activity, stress management, restorative sleep, avoidance of risky substances and positive social connection. Data from epidemiological studies, randomized trials and mechanistic research were synthesized to create guidelines for clinical practice. Dietary interventions—especially the Mediterranean diet and time‐restricted eating—improve hepatic steatosis, insulin sensitivity and inflammatory markers. Physical activity reduces intrahepatic fat, fibrosis and inflammation, even without weight loss. Stress reduction and restorative sleep target pathophysiologic drivers such as cortisol dysregulation and circadian disruption. Avoidance of alcohol and tobacco is critical to slowing disease progression. Social connection, though less studied in MASLD, is associated with improved outcomes in other chronic liver diseases and may enhance adherence to behaviour change. Broader integration of lifestyle medicine into hepatology and primary care is essential to mitigate the growing burden of MASLD. This article offers an evidence‐based guide for applying lifestyle modification in the management of this disease. Routine assessment of the six pillars, incorporation of SMART goals, and consistent, nonjudgmental counselling can empower patients and address the metabolic roots of MASLD.