Metabolic dysfunction-associated steatotic liver disease: epidemiological trends, risk factors, and the role of gut microbiota in disease progression (a literature review)

Background. Metabolic dysfunction-associated steatotic liver disease is one of the most prevalent chronic liver diseases worldwide, affecting approximately 32–35 % of the adult population. The purpose of this review article is to conduct a thorough analysis of epidemiological trends, to identify the main metabolic and gut microbiota-associated risk factors for the development and progression of metabolic dysfunction-associated steatotic liver disease, and to summarize current scientific evidence regarding the pathophysiological role of intestinal microbiota and its therapeutic modulation potential in this condition. Materials and methods. This narrative review was based on a structured search, selection, and analysis of scientific publications indexed in international databases such as PubMed, Scopus, Web of Science, Google Scholar, and open-access Ukrainian medical resources. Only peer-reviewed articles, systematic reviews, meta-analyses, clinical practice guidelines, and multicenter research results published between 2010 and 2025 were included, with priority given to studies from the last five years. A comparative analytical methodology was applied to identify consistencies and contradictions across international and local recommendations. In total, over 80 publications were examined, and 38 of the most relevant and methodologically sound sources were selected for detailed analysis. Results. A strong association with metabolic comorbidities such as insulin resistance, type 2 diabetes mellitus, dyslipidemia, hypertension, and central obesity has been established. Gut microbiota plays a pivotal role in disease progression through the activation of inflammatory pathways and promotion of fibrosis and steatohepatitis. Promising therapeutic strategies include the use of probiotics, prebiotics, symbiotics, and fecal microbiota transplantation. Non-invasive diagnostic indices like FIB-4, NAFLD Fibrosis Score, Hepamet, and ELF are effective tools for early detection and risk stratification. In Ukraine, the lack of standardized clinical algorithms for metabolic dysfunction-associated steatotic liver disease management highlights the necessity for adaptation of international guidelines. The results of this review provide a scientific basis for future clinical strategies aimed at improving diagnosis, monitoring, and prevention of complications such as fibrosis, cirrhosis, and hepatocellular carcinoma. Conclusions. Metabolic dysfunction-associated steatotic liver disease is a pressing global health issue that is closely linked to metabolic disorders and gut microbiota imbalance. This review confirms the pivotal role of the intestinal microbiota in the pathogenesis and progression of this condition and highlights the promising potential of its therapeutic modulation.