Evidence of a gut-adipose-liver axis: microbiota encroachment in metabolic dysfunction-associated steatotic liver disease

Preclinical models implicate the gut microbiota in MASLD pathogenesis, yet translation to humans is hampered by instability and variability in microbial composition. We addressed these gaps by investigating whether stable, quantitative gut phenotypes including microbiota encroachment are pathological features of MASLD.

Sigmoid colon biopsies were collected from participants with and without imaging-defined MASLD. Mucus immunostaining was paired with fluorescent in situ hybridization to image and quantify the distance separating bacteria from the colonic epithelium (i.e., encroachment). Secondary outcomes included intestinal permeability, colon histopathology, and estimates of central and adipose tissue insulin resistance (Adipo-IR).