2020年，提出了代谢功能障碍相关脂肪肝病（MAFLD）的修订定义，以取代非酒精性脂肪肝（NAFLD）。肝脏脂肪变性和三种代谢危险因素中的至少一种，包括 2 型糖尿病、肥胖或代谢失调迹象，可用于诊断 MAFLD。 MAFLD 与 NAFLD 类似，其特点是一系列疾病，从单纯性脂肪变性到伴有或不伴有纤维化的晚期代谢性脂肪肝炎，并可能进展为肝硬化和肝癌，包括增加其他严重肝外疾病的风险。尽管 MAFLD 的病理生理学和潜在的治疗靶点已经得到了详细的探索，但目前还没有美国食品和药物管理局批准的治疗方法。最近，肠道微生物组衍生产物（例如内毒素和代谢物）参与肠道屏障破坏、全身炎症和肝内免疫改变，与 MAFLD 的发生和进展有关。因此，可以采用不同的策略来改变肠道微生物组，以改善早期和进行性 MAFLD 的预后。在这里，我们概述了 MAFLD 患者肝脏脂肪变性发生以及进展为脂肪性肝炎和纤维化期间可能将肠道微生物组与免疫反应联系起来的机制。最后，讨论了基于肠道微生物群的方法作为针对 MAFLD 的潜在个性化治疗方法。© 2024。亚太肝脏研究协会。

In 2020, a revised definition of fatty liver disease associated with metabolic dysfunction (MAFLD) was proposed to replace non-alcoholic fatty liver (NAFLD). Liver steatosis and at least one of the three metabolic risk factors, including type 2 diabetes, obesity, or signs of metabolic dysregulation, are used to diagnose MAFLD. MAFLD, similarly to NAFLD, is characterized by a spectrum of disease ranging from simple steatosis to advanced metabolic steatohepatitis with or without fibrosis, and may progress to cirrhosis and liver cancer, including increased risk of other critical extrahepatic diseases. Even though the pathophysiology of MAFLD and potential therapeutic targets have been explored in great detail, there is yet no Food and Drug Administration approved treatment. Recently, gut microbiome-derived products (e.g., endotoxins and metabolites) involved in intestinal barrier disruption, systemic inflammation, and modification of intrahepatic immunity have been associated with MAFLD development and progression. Therefore, different strategies could be adopted to modify the gut microbiome to improve outcomes in early and progressive MAFLD. Here, we provide an overview of mechanisms that may link the gut microbiome and immune response during the onset of liver steatosis and progression to steatohepatitis and fibrosis in patients with MAFLD. Finally, gut microbiota-based approaches are discussed as potential personalized treatments against MAFLD.© 2024. Asian Pacific Association for the Study of the Liver.