Probiotics as emerging adjuncts in metabolic associated fatty liver disease therapy-a systemic review

Metabolic associated fatty liver disease (MAFLD), a leading cause of chronic liver disorders globally, is closely linked with the dysbiosis of the gut. These microbial imbalances contribute to pathogenesis of MAFLD through intestinal barrier dysfunction, systemic inflammation, and hepatic fat accumulation. This review aims to provide an in-depth analysis of the complex interaction between the gut microbiome and MAFLD, through literature search of articles published in open access journals of two electronic data bases PubMed, Medline from January 2015 to May 2025. Among 602 publications identified initially, 54 studies were considered based on inclusion and exclusion criteria as per the PRISMA guidelines. The results assimilate the findings from both preclinical models and human clinical trials, highlighting the influence of probiotic strains on key metabolic pathways. Lactobacillus and Bifidobacterium species were shown to regulate lipid metabolism, normalize liver enzyme activity, reduce insulin resistance, and attenuate hepatic inflammation. These effects are mediated through multiple mechanisms, including enhancement of gut barrier integrity, modulation of bile acid metabolismsuppression of endotoxemia and modulation of gut–liver axis. By summarizing emerging insights, this review offers an updated perspective on the role of probiotic interventions as a promising adjunct strategy in the prevention and management of MAFLD.