We appreciate the letter and thoughtful suggestions by Fernández GC et al.,1 regarding our work and agree that the issues related to dietary intake and socioeconomic aspects are important for a better understanding of our study results.

Given that prior knowledge about nutrition and access to nutritional education may influence food choices, and in turn, an individual’s metabolic status,2 we collected the clinical, socioeconomic, and nutritional dietary intake data before performing any of the studies or nutritional interventions. Said studies and interventions were only carried out at the end of the protocol, thereby ensuring that any possible differences would be reflected in the results.

Based on the socioeconomic data analyzed, including some that had not been previously published, we found that 90.5% (19) of parents or caregivers of individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) had completed most of their secondary school education, and in the non-MASLD group, that figure was 70.6% (48) (p = 0.084). A family income analysis was also carried out, and in the MASLD group, 61.9% (13) of the families earned salaries below the minimum wage, as did 33.8% (23) of the families in the non-MASLD group (p = 0.022).

MASLD is considered a metabolic disease and is frequently associated with obesity.3 Previous studies suggest that obesity is more prevalent among individuals with lower levels of education and income. Subsequently, those factors lead to limited knowledge about nutrition, the choice of lower-quality foods, and less access to a healthy diet.4,5

In our sample, educational level was not associated with the presence of the disease, but lower family income was statistically associated with MASLD, suggesting a socioeconomic influence and potential influence on food consumption.6 In conclusion, we believe that knowledge of dietary intake before implementing a nutritional intervention may ensure more reliable results. In addition, analyzing and understanding how educational level and family income are associated with the development of metabolic diseases, including MASLD, may importantly impact both the treatment and prevention of the disease, ultimately improving patient management.