Fatty Liver Disease (MASLD)

HYPERTENSION & MASLD PREVALENCE

Study 1:

"Impact of hypertension on liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease"

Authors: Frontiers in Medicine | Published: January 2025

https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1539283/full

Among people with hypertension, 46.08% have MASLD, compared to only 27.86% in those without hypertension. Additionally, 64.24% of people with MASLD have hypertension, demonstrating the bidirectional relationship between these conditions. The study found hypertension severity directly correlates with liver fibrosis progression, with Stage II hypertension showing the highest prevalence of advanced fibrosis.

MASLD IMPROVEMENT WITH LOW-CARB DIET

Study 2:

"Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss"

Authors: MDPI | Published: Nutrients, July 2020

https://www.mdpi.com/2072-6643/12/7/2141

Prospective study of 65 obese patients found that a very low-calorie ketogenic diet (VLCKD) produced profound reductions in fatty liver, with baseline insulin resistance (HOMA-IR) being an independent predictor of liver improvement. Patients with higher insulin resistance benefited most from the low-carbohydrate intervention, showing dramatic liver fat reduction even before achieving 10% weight loss.

KETOGENIC DIET REVERSES INSULIN RESISTANCE

Study 3:

"Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis"

Authors: Nature - Nutrition & Diabetes | Published: November 2020

https://www.nature.com/articles/s41387-020-00142-z

Systematic review and meta-analysis of multiple ketogenic diet studies showed HOMA-IR reductions ranging from -0.4 to -3.4 following ketogenic diets (very low carbohydrate, no grains), with improved insulin receptor sensitivity—directly addressing the root metabolic cause of both hypertension and MASLD.

INSULIN RESISTANCE PREDICTS STROKE RISK

Study 4:

"Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study"

Authors: Columbia University Medical Center | Published: Archives of Neurology, 2010

https://pubmed.ncbi.nlm.nih.gov/20937946/

In an 8.5-year study of 1,509 non-diabetic participants, insulin resistance (HOMA-IR ≥2.8) predicted a 2.83 times higher risk of ischemic stroke, independent of traditional risk factors. This demonstrates that the same metabolic dysfunction causing hypertension and MASLD also dramatically increases stroke risk.

HOMA-IR: STRONGEST PREDICTOR OF CARDIOVASCULAR DISEASE

Study 5:

"Insulin resistance and risk of incident cardiovascular events in adults without diabetes: meta-analysis"

Authors: University Medical Center Utrecht | Published: PLOS One, 2013

https://pubmed.ncbi.nlm.nih.gov/23300589/

Comprehensive meta-analysis of 65 studies (516,000+ participants) found HOMA-IR was a stronger predictor of cardiovascular disease than glucose or insulin alone. For every one standard deviation increase in HOMA-IR, there was a 46% increased risk of coronary heart disease.

INSULIN RESISTANCE WORSENS STROKE OUTCOMES

Study 6:

"Insulin resistance and prognosis of nondiabetic patients with ischemic stroke"

Authors: Beijing Tiantan Hospital | Published: Stroke (American Heart Association), 2017

https://www.ahajournals.org/doi/10.1161/strokeaha.116.015613

Among 1,245 non-diabetic stroke patients, those with insulin resistance had 68% higher mortality, 57% higher stroke recurrence, and 42% worse functional outcomes at one year—demonstrating that insulin resistance significantly worsens both stroke risk and recovery.

MEDITERRANEAN/LOW-CARB DIET IMPROVES INSULIN RESISTANCE

Study 7:

"Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet"

Authors: New England Journal of Medicine | Published: 2008

https://www.nejm.org/doi/full/10.1056/NEJMoa0708681

Among participants with diabetes, the Mediterranean diet group showed a HOMA-IR decrease of 2.3 at 24 months, while the low-fat diet group showed only 0.3 reduction (P=0.02). Lower carbohydrate intake directly improved insulin sensitivity and blood pressure control.

INSULIN RESISTANCE PREDICTS DEPRESSION

Study 8:

"Incident Major Depressive Disorder Predicted by Three Measures of Insulin Resistance"

Authors: Stanford University & University of Amsterdam | Published: American Journal of Psychiatry, 2021

https://psychiatryonline.org/doi/full/10.1176/appi.ajp.2021.20101479

This 9-year study of 601 participants found every one-unit increase in insulin resistance markers meant 89% higher risk of developing depression—demonstrating why early HOMA-IR testing and dietary intervention are crucial for both physical and mental health.

Summary of Evidence

This research demonstrates that hypertension and MASLD (fatty liver disease) are connected through insulin resistance as the unifying pathogenic mechanism. The evidence shows:

• High prevalence: 46% of people with hypertension have MASLD
• Bidirectional relationship: 64% of people with MASLD have hypertension
• Shared root cause: Insulin resistance drives both conditions
• Increased cardiovascular risk: Both conditions dramatically increase stroke and heart disease risk
• Silent progression: MASLD remains undiagnosed for years while causing damage
• Reversibility: Low-carbohydrate dietary interventions reverse both conditions by addressing insulin resistance
• Measurability: HOMA-IR testing detects insulin resistance 10-20 years before conventional tests

Clinical Implication:
Early detection and reversal of insulin resistance—before irreversible organ damage occurs—represents the most impactful intervention for preventing both hypertension progression and fatty liver disease.