The Immune Mechanisms of Metabolic-associated Fatty Liver Disease and Dietary Intervention Strategies

Metabolism-related fatty liver disease has become one of the most common chronic liver diseases globally, affecting about one-quarter of the adult population, with a prevalence of 29.2% in our country, showing a trend towards younger age groups. This disease is characterized not only by the accumulation of fat in the liver but also involves multidimensional pathological processes such as abnormal lipid metabolism, insulin resistance, and inflammatory immune responses. Among them, the abnormal activation of the immune system is the core driving force of disease progression, including disorders in the innate immune signaling pathways (such as Kupffer cell polarization dysfunction and excessive activation of the Nucleotide-binding oligomerization domain (NOD)-like receptor protein 3 inflammasome) and imbalances in adaptive immunity (dysfunction of T cell subsets). At the same time, the gut microbiota regulates the hepatic immune microenvironment through metabolites and barrier functions, forming an "gut-liver" inflammatory loop.This study systematically reviews the immunopathological mechanisms of metabolic associated fatty liver disease, focusing on the interaction between innate and adaptive immunity, and integrates the latest clinical evidence to compare the immunomodulatory effects of dietary patterns such as the Mediterranean diet, intermittent fasting, and dietary fiber interventions. Based on patient BMI indices, genotypes, and gut microbiome characteristics, precise dietary intervention strategies are proposed. The research results provide theoretical support and practical guidance for the prevention and treatment of metabolic-associated fatty liver disease.