A new study in eGastroenterology links gut dysbiosis with severe steatosis in metabolic dysfunction–associated steatotic liver disease (MASLD). In a 61-patient cohort, those with the inflammation-linked Bact2 enterotype developed severe steatosis at lower thresholds. Adding microbiota status to standard clinical tools improved diagnostic accuracy from 80% to 90%, suggesting a path toward earlier detection and personalized care.
MASLD: A Growing Global Burden
Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly termed non-alcoholic fatty liver disease (NAFLD), is now the most common chronic liver disorder worldwide. Affecting nearly 38% of the global population, its prevalence parallels the epidemic of metabolic syndrome (MetS), a cluster of conditions including obesity, insulin resistance, and dyslipidaemia. Excessive fat accumulation in the liver, known as hepatic steatosis, drives disease progression, increases the risk of fibrosis, cirrhosis, and liver cancer.
Early identification of patients at risk of severe steatosis is crucial, yet current clinical tools such as the Fatty Liver Index (FLI) are imperfect. Mounting evidence points to the gut microbiota—disrupted in both MASLD and MetS—as a potential player in improving diagnosis.
Study Design and Key Findings
The new study, led by Professor Sara Vieira-Silva, analysed data from the microDHNA cohort, a cross-sectional study of 61 patients with MetS across different stages of MASLD. Participants underwent liver imaging, clinical evaluation, and gut microbiota profiling.
This finding demonstrates that simple microbial community typing can substantially strengthen non-invasive diagnostic tools.
Biological Implications of the Bact2 Enterotype
Beyond diagnostics, the study highlights the biological significance of dysbiosis. The Bact2 enterotype is characterised by reduced butyrate producers, depletion of metabolic diversity, and increased inflammatory potential. Prior research shows that this enterotype impairs glucose metabolism, increases bile acid production, and weakens gut barrier function. Together, these changes may promote systemic inflammation and exacerbate liver fat accumulation. Thus, dysbiosis is not just a biomarker—it may be an active driver of steatosis progression.
Clinical R elevance and N ext S teps
The study suggests that profiling a patient’s gut microbiota could:
The authors caution that larger, longitudinal studies are needed to confirm whether restoring gut microbial balance can slow MASLD progression.
In conclusion, this study provides compelling evidence that gut dysbiosis, particularly the inflammation-linked Bact2 enterotype, is strongly associated with severe hepatic steatosis in MASLD. Incorporating microbiota profiling with established clinical predictors significantly improves diagnostic accuracy.
eGastroenterology
Gut dysbiosis is linked to severe steatosis and enhances its diagnostic performance in MASLD