代谢功能障碍相关的脂肪性肝病 (MASLD) 涵盖多种肝损伤，从肝脂肪变性、代谢功能障碍相关的脂肪性肝炎 (MASH)、纤维化、肝硬化到 MASLD 相关的肝细胞癌 (MASLD-HCC)。最近的研究强调了宿主遗传学/表观遗传学与肠道微生物群落之间的双向影响。宿主遗传学影响肠道微生物群的组成，而肠道微生物群及其衍生代谢物可以诱导宿主表观遗传修饰，从而影响 MASLD 的发生。对肠道微生物群与宿主遗传/表观遗传组成之间复杂关系的探索预计将为针对 MASLD 及其相关病症的治疗干预提供有希望的途径。在这篇综述中，我们总结了肠道微生物组、宿主遗传学和表观遗传改变对 MASLD 和 MASLD-HCC 的影响。我们进一步讨论了证明肠道微生物组与宿主遗传学/表观遗传学之间双向影响的研究结果，强调了这种相互关联在 MASLD 预防和治疗中的重要性。© 作者（或其雇主）2024。允许重复使用CC BY-NC。禁止商业再利用。请参阅权利和权限。由英国医学杂志出版。

Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a wide spectrum of liver injuries, ranging from hepatic steatosis, metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis to MASLD-associated hepatocellular carcinoma (MASLD-HCC). Recent studies have highlighted the bidirectional impacts between host genetics/epigenetics and the gut microbial community. Host genetics influence the composition of gut microbiome, while the gut microbiota and their derived metabolites can induce host epigenetic modifications to affect the development of MASLD. The exploration of the intricate relationship between the gut microbiome and the genetic/epigenetic makeup of the host is anticipated to yield promising avenues for therapeutic interventions targeting MASLD and its associated conditions. In this review, we summarise the effects of gut microbiome, host genetics and epigenetic alterations in MASLD and MASLD-HCC. We further discuss research findings demonstrating the bidirectional impacts between gut microbiome and host genetics/epigenetics, emphasising the significance of this interconnection in MASLD prevention and treatment.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.