Insights Into Intestinal Flora in Metabolic Dysfunction‐Associated Steatotic Liver Disease

Metabolic dysfunction‐associated steatotic liver disease (MASLD) is a metabolic disease characterized by excessive accumulation of liver fat, encompassing nonalcoholic fatty liver (NAFL) and metabolic dysfunction‐associated steatohepatitis (MASH), which is among the rapidly proliferating diseases globally. MASLD disrupts the normal structure and function of the liver, resulting in liver fibrosis, cirrhosis, and ultimately hepatocellular cancer and other severe outcomes. Recent investigations have demonstrated that intestinal flora significantly influence the development of MASLD. The proliferation of intestinal flora in the context of MASLD exacerbates the dysbiosis of intestinal flora. Dysbiosis of intestinal microbiota impairs the intestinal barrier, facilitating the translocation of intestinal flora and its metabolites into the portal circulation, resulting in hepatic injury and the subsequent onset of MASLD. Furthermore, intestinal flora facilitates the onset of NAFLD through endotoxin production and involvement in bile acid metabolism. The possible regulating function of additional intestinal flora‐related metabolites in MASLD has garnered heightened interest. Herein, we outline the probable relationship between intestinal flora and MASLD, highlighting the significant research value and developmental possibilities of novel pharmacological interventions aimed at intestinal microbiota for the treatment of MASLD.