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REVIEW ARTICLE

Obesity-associated gut dysbiosis: Metabolic dysfunction-associated steatotic liver disease as a clinical model of host–microbiome interactions

Alexander Plakida1* ,  Oksana Moskal2 ,  Sergiy Gushcha3
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1 Department of Physical Rehabilitation, Sports Medicine and Physical Education, Medical Faculty No. 2, Odesa National Medical University, Odesa, Odesa Region , Ukraine
2 Department of Internal Diseases, Medical Faculty No. 2, Uzhhorod National University, Uzhhorod, Zakarpattia Region , Ukraine
3 Department of Experimental Research, State Non-profit Enterprise “Ukrainian Research Institute of Rehabilitation and Balneology of the Ministry of Health of Ukraine”, Odesa, Odesa Region , Ukraine
MI, 026270079 https://doi.org/10.36922/MI026270079
Received: 1 July 2026 | Revised: 8 August 2026 | Accepted: 18 August 2026 | Published online: 15 October 2026
(This article belongs to the Special Issue Obesity and Human Microbiome)
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Obesity is associated with profound alterations in the composition and function of the gut microbiota that extend far beyond the gastrointestinal tract. Accumulating evidence indicates that obesity-associated gut dysbiosis influences intestinal barrier integrity, immune regulation, microbial metabolism, and systemic metabolic homeostasis through interconnected biological mechanisms. These alterations contribute to the development of chronic metabolic disorders affecting several organ systems. This review summarizes current knowledge regarding the host–microbiome interactions linking obesity-associated gut dysbiosis with metabolic dysfunction. Particular attention is given to the sequential interactions between microbial ecosystem remodeling, impaired intestinal barrier function, chronic low-grade inflammation, and metabolic disturbances that collectively promote obesity-associated diseases. Rather than focusing exclusively on liver pathology, metabolic dysfunction-associated steatotic liver disease is presented as one of the best-characterized clinical models demonstrating how disturbances originating within the gut microbiome evolve into systemic metabolic disease. Finally, emerging therapeutic strategies targeting the gut–microbiome axis are discussed, with emphasis on restoration of microbial homeostasis and early intervention aimed at interrupting pathophysiological progression before irreversible metabolic complications develop. These approaches may contribute to preventing or attenuating obesity-associated metabolic complications.

Graphical abstract
Keywords
Gut microbiota
Obesity
Gut dysbiosis
Intestinal barrier
Metabolic dysfunction
Metabolic dysfunction-associated steatotic liver disease
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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