Does the microbiome matter in metabolic liver disease? 

Our dietitians Dr Georgina and Dr Kerith recently published a paper which aimed to explore the associations between diet and the gut microbiome in people with Metabolic Associated Steatotic Liver Disease (MASLD).  

MASLD (formerly known as NAFLD) is now the most common chronic liver condition worldwide. While diet and lifestyle are central to managing MASLD, the role of the gut microbiome is still not fully understood. We know that diet strongly shapes the gut microbiota and influences health, so we wanted to explore which foods and nutrients are linked to healthier gut microbiomes — and whether these patterns differ in people with MASLD. 

What did the study do? 

We recruited 25 adults with MASLD and 25 healthy individuals (to compare with). They collected: 

• Dietary intake data using detailed 3-day food records 

• Stool samples to analyse gut microbes using advanced DNA sequencing 

• Clinical health markers including body measurements and liver assessments 

How did diet differ between groups?  

Compared to healthy controls, individuals with MASLD consumed significantly less: 

• Dietary fibre — found in whole grains, fruits, and vegetables 

• Very long-chain omega-3 fats — such as those in oily fish like salmon 

• Nuts and seeds 

• Whole grains and vegetables  

At the same time, MASLD participants tended to consume more saturated fats and added sugars — nutrients often linked with inflammation and poor metabolic health. 

How did the gut microbiome differ between groups?  

The gut microbiome profiles of individuals with MASLD showed: 

• Lower abundance of beneficial microbes e.g. Faecalibacterium, Coprococcus, Alistipes 

• Higher abundance of microbes like Ruminococcus torques, which are sometimes associated with dysbiosis (an unhealthy gut microbial balance)  

Many of these microbial differences were associated with diet quality — meaning how much fiber, healthy fats, and plant foods people ate matched with the abundance of healthy microbes present in their gut  

I have MASLD, what does this mean for my diet? 

The study’s findings suggest that diet quality influences both the gut microbiome and liver health indicators.   

1. A Mediterranean-style pattern may be protective 
Foods like whole grains, vegetables, nuts, seeds, and omega-3-rich fish were more common in people without MASLD, aligning with Mediterranean diet principles that are anti-inflammatory and support diverse gut microbes.  

2. Fiber matters for the gut microbiome 
Adequate fiber intake was strongly associated with beneficial microbes. These microbes produce metabolites like short-chain fatty acids that support gut health and may reduce inflammation — a key factor in liver disease progression.  

3. Dietary fats make a difference 
Unsaturated fats (from nuts, seeds, fish) were linked with healthier microbiome profiles, while saturated fats and added sugars were linked with patterns observed in MASLD.  

This was a case-control study — meaning it can show associations, not cause and effect. It’s still unclear whether altering the diet will certainly change the gut microbiome in ways that improve MASLD outcomes, although the data point in a promising direction. Future research is needed to test specific dietary interventions and track how microbial changes influence liver health over time.  

4. Choose a dietitian who has specialist experience 

Unpacking the confusing and sometimes conflicting information on MASLD online can be exhausting, especially when you then have to apply that in your own life, with you own food preferences and specific health needs and goals. Help Yourself Dietitians can take the pressure out of this process by doing all the unpacking with you to match the best evidence and apply it for you, with you.   

Link to article here