Milpa Diet for MASLD in Mesoamerican Populations: Feasibility, Advantages, and Future Perspectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease, linked closely to metabolic syndrome and rising obesity rates. Affecting up to 37% of the global adult population, MASLD prevalence is exceptionally high among individuals of Hispanic descent, with genetic factors such as the PNPLA3 gene mutation playing a significant role. The subject of this review is the traditional Mesoamerican “milpa” diet, which includes unprocessed local crops like maize, beans, pumpkins, chili, and tomatoes and may represent a strategy to combat MASLD. Current treatment recommendations emphasize weight loss; a reduced intake of saturated fats, processed meats, and added sugars; and increased physical activity. The milpa diet, rich in protein, fiber, vitamins, and bioactive compounds, aligns with these recommendations and could potentially mitigate MASLD by preventing liver fat accumulation and fibrosis. This narrative review focuses on available preclinical and clinical studies adopting the milpa diet as a culturally relevant, nutritious, and sustainable dietary approach in preventing and treating MASLD. More clinical studies are needed to develop precise nutritional quantitative recommendations and guidelines.