Daily tomato consumption significantly reduced liver fat in adults with MASLD in the randomized POMOSANO trial, while liver fibrosis, body composition, and metabolic biomarkers remained unchanged.
Written By: Rishabh Sonawane, BPharm
Reviewed By: Pharmacally Editorial Team
Daily tomato consumption may offer a simple dietary strategy to reduce liver fat in adults with metabolic dysfunction-associated steatotic liver disease (MASLD), according to findings from the exploratory randomized controlled POMOSANO study (NCT06389851) published in Nutrients. The six-week trial demonstrated that daily consumption of raw tomatoes and tomato sauce produced a significantly greater reduction in hepatic steatosis than a tomato-free control diet.
However, no significant improvements were observed in liver fibrosis, metabolic biomarkers, or body composition. The findings support the potential role of tomato-rich dietary interventions as an adjunct to lifestyle management while highlighting the need for larger, adequately powered confirmatory studies.
Randomized Trial Evaluated Tomato Consumption in Adults with MASLD
The POMOSANO study enrolled 79 adults aged 18 to 65 years with MASLD and a body mass index (BMI) of 30 kg/m² or lower. Participants were randomly assigned to consume 200 g of raw tomatoes and 50 g of tomato sauce daily (n=42) or follow a tomato-free diet (n=37) for six weeks while maintaining their usual lifestyle habits.
Randomization was computer generated by an independent biostatistician with allocation concealment, and outcome assessments, including FibroScan® measurements, were performed by blinded operators. Hepatic steatosis was assessed using the FibroScan® controlled attenuation parameter (CAP), which served as the primary endpoint.
Secondary assessments included liver stiffness, Fibrosis-4 (FIB-4) index, Fatty Liver Index (FLI), body composition, anthropometric measurements, and metabolic and biochemical parameters.
Tomato-Based Intervention Produced a Significantly Greater Reduction in Hepatic Steatosis
At the end of the six-week intervention, both groups experienced reductions in CAP values, but the improvement was significantly greater among participants receiving tomatoes. Median CAP declined from 306.5 to 272.5 dB/m in the intervention group, corresponding to a median reduction of 35 dB/m, compared with a median reduction of 18 dB/m in the control group.
The between-group difference reached statistical significance (p=0.0433), and CAP values at follow-up were significantly lower in the intervention group than in the control group.
Adjusted mixed-effects analyses further supported these findings. While no significant baseline differences in CAP were observed between groups, the treatment-by-time interaction remained statistically significant (β = −26.63; 95% CI, −44.00 to −9.25; p=0.0030), indicating that the tomato intervention produced a greater reduction in hepatic steatosis independent of age, sex, and BMI.
The control group also demonstrated a modest reduction over time (β = −12.81; 95% CI, −25.55 to −0.08; p=0.0490), but the intervention group achieved a substantially larger treatment effect.
Secondary Outcomes Showed No Significant Changes
Despite the improvement in liver fat, the intervention did not produce significant differences in several secondary endpoints. Liver stiffness, FIB-4 index, Fatty Liver Index (FLI), body weight, waist circumference, total body fat, visceral adiposity, and dual-energy X-ray absorptiometry (DXA)-derived body composition remained comparable between groups after six weeks.
Likewise, no statistically significant differences were detected in glucose metabolism, glycated hemoglobin (HbA1c), lipid profile, liver enzymes, inflammatory markers, or other biochemical parameters. These findings indicate that reductions in hepatic steatosis occurred despite minimal changes in overall and abdominal adiposity and independently of major changes in body weight or systemic metabolic markers during the short intervention period.
Proposed Biological Mechanisms Support Tomato-Rich Dietary Strategies
The investigators proposed several biological mechanisms that could explain the observed reduction in hepatic steatosis. Tomatoes are rich in lycopene, β-carotene, polyphenols, and other antioxidant phytochemicals characteristic of the Mediterranean diet. Experimental evidence discussed in the study suggests that these compounds may reduce oxidative stress, modulate inflammatory signaling, improve hepatic lipid metabolism, and influence pathways including SIRT1, AMPK, adiponectin, and PPARα, all of which have been implicated in MASLD pathogenesis.
The combined use of raw tomatoes and tomato sauce may have enhanced exposure to complementary tomato-derived bioactive compounds because cooking increases lycopene bioavailability while fresh tomatoes provide heat-sensitive micronutrients and phytochemicals. The authors emphasized that these proposed mechanisms are based largely on experimental evidence and were not directly evaluated in the present clinical trial.
Study Limitations and Clinical Implications
The investigators emphasized that the trial was exploratory and was not powered to establish definitive clinical efficacy. Limitations included the relatively small sample size, the six-week intervention period, reliance on dietary counselling and participant adherence, and the absence of circulating carotenoid or lycopene measurements. Consequently, the findings should be considered hypothesis-generating rather than practice-changing.
Nevertheless, the study provides randomized clinical evidence that a simple tomato-based dietary intervention may reduce hepatic fat accumulation without requiring substantial weight loss. While larger, longer-duration randomized controlled trials are needed to confirm these findings and further investigate the underlying mechanisms, the results support continued evaluation of tomato-rich dietary strategies as a complementary nutritional approach for adults with MASLD.
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About the Writer
Rishabha Sonawane, B.Pharm (LinkedIn) is healthcare writer with a strong interest in medical writing, regulatory affairs, clinical research, and AI-driven drug discovery. He has completed specialized training from the NIH and ICMR in clinical pharmacology, clinical research, and scientific writing. Passionate about evidence-based healthcare communication, he focuses on translating complex scientific research into clear, accurate, and engaging medical content.