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Abstract: Metabolic associated fatty liver disease (MAFLD) is the most common chronic
liver disease worldwide and can progress to steatohepatitis, cirrhosis and hepatocellular
carcinoma. Recent studies showed that gut-liver axis dysregulation was one of the upstream
factors driving MAFLD. During MAFLD progression, the intestinal microbiome exhibited
characteristic alterations, and microorganisms along with their structures, microbe-derived
outer membrane vesicles, enzymes and metabolites drive MAFLD development through a
compromised intestinal barrier. Strategies targeting the gut-liver axis, such as supplementation
with intestinal microbes, prebiotics, postbiotics, bile acids and other microbial metabolites,
alleviated MAFLD by improving intestinal barrier integrity and metabolism. Future ef forts
should stratify patients based on their gut microbiome characteristics, conduct in-depth
multicenter longitudinal studies, and advance the application of gut-liver axis-targeted
therapies in precision medicine for MAFLD.
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