Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic progressive liver disease primarily characterized by overnutrition and insulin resistance in genetically predisposed individuals. MASLD may progress to metabolic dysfunction-associated steatohepatitis (MASH), further inducing liver fibrosis and cirrhosis. The prognosis of MASLD is mainly related to cardiovascular disease. The combination of progressive fibrosis significantly increases the incidence of hepatocellular carcinoma. The global prevalence of MASLD is as high as 37.8%, with considerable regional variations. This disease is highly prevalent in overweight and obese populations, although it also affects some non-obese or lean MASLD patients. Over the past two decades, the prevalence of MASLD in Chinese adults has been approximately 29.6%, with a higher incidence in males (34.8%) compared with females (23.5%). The disease is also gradually replacing viral hepatitis and is poised to rank first among chronic liver diseases in China. Hence, MASLD has emerged as a critical public concern worldwide, underscoring the urgent demand for enhanced screening and prevention strategies. The clinical management of MASLD faces serious challenges due to the lack of effective diagnostic and therapeutic tools, thus imposing a heavy burden on healthcare systems. Currently, the crosstalk between the liver and gut has been recognized by an increasing number of scholars. In MASLD, significant changes in the composition and metabolites of gut microbiota suggest that therapeutic strategies targeting the gut microbiota may contribute to the decelerated progression of steatohepatitis and fibrosis. Therefore, the potential clinical value of gut microbiota profiles as non-invasive markers of metabolism-associated steatohepatitis is analyzed in this paper based on the influence of gut microbiota and its metabolites in the pathogenesis of MASLD. Furthermore, the potential preventive and therapeutic interventions related to gut microbiota for the treatment of MASLD are also explored from the perspectives of probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and emerging therapies. In this paper, we summarise the role of gut microbiota and its metabolites in the pathogenesis of MASLD, and describe the potential preventive and therapeutic efficacy of gut microbiota as a non-invasive marker to regulate the pathogenesis of MASLD based on the "gut-hepatic axis", which will provide new therapeutic ideas for the clinic.

Metabolic Dysfunction-Associated Steatotic Liver Disease, Gut-Liver Axis, Gut Microbiota, Probiotics, Metabolites