Breaking the barriers: the role of gut homeostasis in Metabolic-Associated Steatotic Liver Disease (MASLD)

Summary

This narrative review synthesises the complex interplay between the gut microbiome, intestinal barrier function, and metabolic-associated steatotic liver disease (MASLD), integrating the gut-liver axis framework. The authors examine how dysbiosis and impaired barrier integrity drive systemic inflammation and disease progression through multiple pathways including toll-like receptor signalling, and present evidence-based management strategies including dietary intervention, physical exercise, bile acid-targeting pharmacotherapy, and microbiota modulation techniques such as prebiotics, probiotics, and faecal microbiota transplantation.

Regional applicability

The review is a mechanistic synthesis of pathophysiology and therapeutic approaches applicable to clinical and public health contexts globally, including the United Kingdom, where MASLD prevalence is rising. The therapeutic strategies discussed (dietary modification, exercise, targeted pharmacotherapy, and microbiota interventions) are relevant to UK clinical practice and health policy, though implementation and access to emerging therapies (e.g. FMT) vary by healthcare setting.

Key measures

Gut barrier integrity (mechanical, immune, and microbial components); dysbiosis markers; toll-like receptor signalling; inflammatory biomarkers; liver fat accumulation and hepatic fibrosis; therapeutic outcomes from dietary, exercise, and microbiota modulation interventions

Outcomes reported

The review examines the role of gut homeostasis and the gut-liver axis in MASLD development, integrating evidence on dysbiosis, intestinal barrier dysfunction, and immune signalling pathways. It synthesises current dietary, pharmacological, and microbiome-modulating therapeutic strategies for disease management.

Supporting research

Author abstract explicitly covers dietary interventions and prebiotic/probiotic gut approaches alongside MASLD pathophysiology and pharmacotherapy.

Limits: Mixed clinical/mechanistic review, not a completed dietary randomised trial. Treatment effects, preparation-specific risks and clinical recommendations were not independently validated.

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