Prebiotic and Probiotic Foods in MASLD: Microbiome-Mediated Therapeutic Strategies

ABSTRACT: Through the use of prebiotics and probiotics, fermented foods offer significant health benefits by enhancing host nutrition and microbiota composition while providing distinctive flavor profiles. Fermentation substantially alters the bioactive compounds in these foods compared to their natural state. Additionally, fermented foods contain probiotics that can modulate consumers’ gut microbiomes, which in turn regulate host biochemistry to help combat various metabolic diseases. Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a growing global health burden. Gut microbiome dysbiosis, combined with unbalanced nutritional intake, is considered a primary driver of disease pathogenesis. Fermented foods can modify the bioavailability of micronutrients—including carbohydrates, polyphenols, and vitamins—thereby influencing host metabolism. Moreover, the probiotics present in fermented foods, along with their modulatory effects on the gut microbiota, contribute to both the management and prevention of MASLD. Modern fermentation approaches, leveraging synthetic biology, systems biology, and metabolic engineering, can further maximize these health benefits. This review summarizes the components, bioactive compounds, and mechanistic pathways by which fermented foods influence the pathogenesis of MASLD, and highlights the potential applications of modern fermentation technologies to enhance their health-promoting properties.