The Vicious Circle of Metabolic Dysfunction-Associated Steatotic Liver Disease When Micronutrient Deficiency Drives Microbial Imbalance and Liver Injury.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an escalating global health burden and a leading cause of chronic liver disease. Without intervention, MASLD can progress to steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Although lifestyle modification is the cornerstone of management, specific dietary patterns are a primary driver of its development. The progression of MASLD is closely linked to micronutrient status, as these nutrients are critical for key biological functions such as antioxidant defense and immune regulation. Micronutrient deficiencies-particularly in essential vitamins and minerals-have been widely studied as independent contributors to MASLD pathogenesis. Similarly, the role of the gut microbiota in disease development has gained attention. However, the interplay between micronutrient deficiencies and gut dysbiosis is often underestimated. Emerging evidence suggests that micronutrient depletion not only directly exacerbates MASLD but also alters gut microbial composition, perpetuating a cycle of metabolic and hepatic dysfunction. This review aims to highlight the bidirectional relationship between micronutrient deficiency and gut microbiome imbalance in MASLD. It explores how dysbiosis impairs the bioavailability of micronutrients, thereby reinforcing a vicious cycle of disease progression. Therefore, effective MASLD management should address both nutritional deficiencies and microbial imbalances. Interventions such as prebiotic and probiotic supplementation may help restore microbial equilibrium and improve micronutrient absorption. Looking forward, personalized therapeutic strategies that combine targeted microbiota modulation with micronutrient repletion may offer promising approaches to curb the rising global burden of MASLD.