The goal of this clinical trial is to evaluate the effect of Ancestry, a supplement made from Mexican-origin foods (nopal, cacao, and cricket) in adults with Metabolic dysfunction-associated steatotic liver disease (MASLD). The main questions it aims to answer are:

• Does the supplementation with Ancestry improve the hepatic steatosis grade in participants with MASLD?
• Does the supplementation improve biochemical and anthropometric parameters in participants with MASLD?
• Does the supplementation enrich the abundance of beneficial bacteria in the gut microbiota of participants?

Researchers will compare the supplement group to a placebo group to see if the supplement is effective.

Participants will:

• Take the supplement or a placebo every day for 3 months.
• Receive nutritional guidance from a trained dietitian to control dietary intake.
• Attend follow-up clinic visits every month for monitoring and checkups.

The study will follow a randomized double-blind design. Randomization will be performed in matched pairs according to sex, age (±3 years), diabetes status, body mass index (BMI), and degree of hepatic steatosis. An investigator not involved in participant follow-up will generate a coded randomization list to assign participants to the supplement or placebo group.

Investigators involved in participant assessments and sample processing, as well as study participants, will remain blinded to group allocation throughout the intervention. The supplement and placebo will be provided in identical packaging to maintain blinding.

Hepatic steatosis and fibrosis will be evaluated using the FibroScan Expert 630 device (Echosens, Paris, France), a vibration-controlled transient elastography (VCTE) system, by a physician specialized in hepatology and gastroenterology.

Nutritional consultations and dietary prescriptions will be provided by a trained nutritionist following the clinical recommendations established by the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) for MASLD management.

Anthropometric assessment will include height and waist, abdominal, and hip circumferences measured using a Lufkin Rosscraft W606 metallic measuring tape. Body composition analysis will be performed using the InBody 720 bioimpedance analyzer (Biospace), which will provide measurements of body weight, body fat percentage, and visceral fat. All measurements will be interpreted according to standardized guidelines and reference cut-off values.

Inclusion Criteria:

• Mexican mestizo adults of both sexes between 18 to 60 years old
• Diagnosis of MASLD according to the criteria established by the American Association for the Study of Liver Diseases
• Controlled Attenuation Parameter (CAP) score >248 dB/m, liver stiffness <14 kPa according to FibroScan Expert 630 (Echosens, Paris, France)
• Obesity diagnosed by body fat percentage
• Bristol stool scale type 3-4
• Physical inactivity according to the International Physical Activity Questionnaire (IPAQ)
• Alcohol consumption <20 grams/day for women and <30 grams/day for men
• Signed informed consent

Exclusion Criteria:

• Severe gastrointestinal diseases (e.g., chronic constipation, Crohn's disease, celiac disease, ulcerative colitis, irritable bowel syndrome, diverticulosis, etc.), autoimmune diseases, and malignant neoplasms
• Current or prior 6 weeks consumption of probiotic formulations
• Current or prior 2 months consumption of antibiotics or antiparasitic drugs before the start of the study
• Current consumption of dietary supplements (omega-3 fatty acids, thermogenics, protein, teas, etc.)
• Frequent consumption (greater than or equal to twice a week) of anti-inflammatory drugs, analgesics, or medications that alter normal intestinal function (e.g., laxatives, enemas, antidiarrheal agents, etc.)
• Pregnant women, women planning pregnancy, or breastfeeding women
• Weight loss greater than three kilograms in the last month
• Tobacco consumption
• Allergy or intolerance to cacao, nopal, or crickets
• Previous malabsorptive bariatric surgery (gastric bypass, sleeve gastrectomy), restrictive bariatric surgery (adjustable gastric band), or cosmetic surgical procedures (liposuction, lipo-sculpture, abdominoplasty, etc.) in the last 2 years

All IPD underlying the results reported in publications derived from this study will be shared with investigators interesteted in this area, including demographic, clinical, biochemical, anthropometric, dietary, and microbiota-related data, after de-identification to protect participant confidentiality. A data dictionary will also be provided to facilitate data interpretation.

Starting 8 months after publication

De-identified IPD will be made available to qualified researchers upon reasonable request. Access will be granted for scientifically sound research purposes, including secondary analyses, meta-analyses, and validation studies. Requests will be reviewed by the principal investigator and the research team based on the scientific merit of the proposal, the protection of participant confidentiality, and compliance with applicable regulations. Data will be shared through a secure electronic transfer system after approval of a data access agreement.

The researchers administering the supplements, conducting interviews, and following up with patients will remain "blind" to the study throughout the intervention period. Similarly, the personnel responsible for assessing the primary outcome (hepatic steatosis degree).