Ketogenic Diet Cuts Liver Fat Most in Trial

A small Washington University study found a ketogenic diet reduced liver fat more than Mediterranean or low-fat plant-forward diets.

Updated on Nov. 6, 2026 in Nutrition

Bold flat-color vector illustration of a halved avocado, a bowl of olive oil, and an amber liver-shaped form on a pale wooden surface. — Researchers at Washington University found a ketogenic diet reduced liver fat more than Mediterranean or low-fat plant-forward diets in a 42-person trial. AI Illustration. Upload story photo >

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Researchers at Washington University School of Medicine randomly assigned 42 people with obesity, prediabetes, and fatty liver disease to a ketogenic, Mediterranean, or low-fat plant-forward diet. All three groups lost about 10% of body weight and became more sensitive to insulin, but liver fat fell most on the ketogenic plan.

Why it matters

Fatty liver disease is closely tied to obesity and prediabetes, so a dietary approach that reduces liver fat more effectively could inform how clinicians manage these conditions. The study suggests that the type of diet may matter beyond the amount of weight lost.

The randomized trial of 42 participants compared liver fat reduction across three diets, with the ketogenic group averaging a 67% drop versus about 45% for the other two. The trial did not report long-term outcomes, and whether these liver fat differences lead to lasting health benefits remains unknown.

The players

Washington University School of Medicine

A leading academic medical center in St. Louis, Missouri, where the trial was conducted.

The details

Researchers supplied all meals and adjusted calories so each group lost around 10% of starting weight, taking roughly four to five months. The ketogenic plan provided about 4% of calories from carbohydrates and 73% from fat, while the Mediterranean plan supplied about half of calories from carbohydrates and the low-fat plan about 70%.

Participants reached roughly 10% weight loss over approximately four to five months.

Health Landscape

The trial adds to a growing body of research testing dietary patterns against fatty liver disease, a condition with few approved drug treatments. Its head-to-head comparison of three common diet styles gives clinicians a clearer picture of how macronutrient balance may affect the liver.

For people with fatty liver disease or prediabetes, the findings suggest diet composition may matter alongside weight loss when choosing an approach. Anyone considering a ketogenic diet should discuss it with a clinician, since the study was small and short-term.

The takeaway

Weight loss alone may not capture every metabolic benefit of a diet, since the type of diet appeared to influence liver fat reduction. Larger, longer studies will be needed before any single diet is recommended for fatty liver disease.