Purpose <p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health concern in Asia, where dietary patterns differ significantly from those in Mediterranean regions. Although the Mediterranean Diet (MedDiet) is recommended for MASLD management, its adoption in Asia remains limited. This study aimed to develop a culturally adapted Asian Mediterranean Diet (AMED) and to evaluate its sensory acceptability among individuals with MASLD.</p> Methods <p>A multi-phase methodology with a cross-sectional study design was employed, involving dietary mapping, portion standardization, recipe development, polyphenol profiling, and sensory evaluation. A 4-week AMED menu was formulated using culturally relevant ingredients and cooking methods. Nutritional composition and polyphenol content were determined. Sensory evaluation of 14 AMED dishes was conducted among 30 MASLD patients using a 7-point hedonic scale across six sensory domains.</p> Results <p>Twelve out of 14 dishes (85.7%) received favourable sensory scores (≥ 5). Texture was the strongest predictor of overall taste and acceptability (β = 0.83, <i>p</i> &lt; 0.001). Polyphenol analysis revealed substantial antioxidant content across several dishes. The AMED menu met key MedDiet macronutrient targets and incorporated polyphenol-rich ingredients aligned with dietary recommendations for MASLD.</p> Conclusion <p>The AMED represents a culturally adapted, nutritionally coherent, and sensory-acceptable interpretation of the MedDiet for Asian populations. These findings provide a foundation for future clinical trials and public health strategies targeting cardiometabolic diseases in Asian populations.</p> Trial registration <p>NCT06321211; <a href="https://clinicaltrials.gov/study/NCT06321211?term=NCT06321211%26rank=1">https://clinicaltrials.gov/study/NCT06321211?term=NCT06321211&amp;rank=1</a>. Registration date: 30 March 2024.</p>