Dietary Strategies to Modulate Gut Microbiota in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Abstract

Gut microbiota has become an area of increasing interest for its potential role in metabolic dysfunction-associated steatotic liver disease (MASLD) and its more advanced form, metabolic dysfunction-associated steatohepatitis (MASH)-now recognized as the most frequent liver disease worldwide. Research suggests that imbalances in the intestinal microbiota, including dysbiosis and increased intestinal permeability, may contribute to the pathogenesis of MASLD and progression to MASH. These changes affect insulin resistance and trigger inflammatory responses by disrupting the gut-liver axis. This review examined the current evidence connecting gut microbiota to MASLD and MASH, exploring how microbial shifts might influence liver health. Emerging strategies-such as probiotics, prebiotics, and targeted dietary changes-that may help prevent or manage these conditions are also discussed. Finally, key areas where further studies are required to understand the role of microbiota and its therapeutic potential are highlighted.

Keywords: MASH; MASLD; NAFLD; NASH; cirrhosis; diet; fibrosis; liver; metabolic dysfunction-associated steatohepatitis; metabolic dysfunction-associated steatotic liver disease; microbiota; non-alcoholic fatty liver disease; non-alcoholic steatohepatitis; nutrition; portal hypertension.

Figure 1

Principal modulators of gut microbiota in the MASLD. Nuclear factor-κB (NF-κB), lipopolysaccharide (LPS).

Figure 2

The primary metabolites that contribute to the alteration of the microbiota exert a positive influence on the natural progression of MASLD. Receptor of Glucagon-Like Peptide—1 (GLP-1 r); lipopolysaccharide (LPS).