Resistant starch intervention in patients with MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) is affecting over 30% of adults globally. But effective treatment options remain limited. Resistant starch (RS) have been found to reduce intrahepatic triglyceride content (IHTC), offering a novel therapeutic approach. However, there is heterogeneity in treatment responses, with some patients showing marked improvements in IHTC while others did not, which limits therapeutic application of RS. Therefore, to explore the underlying causes of the heterogeneity and identify strategies to extend benefits to a broader cohort of people with MASLD, we conducted a multicenter, single-arm RS intervention trial. By integrating shotgun metagenomic sequencing and changes of clinical indicators, we characterised the baseline gut microbiota composition, especially two keystone bacteria, as a driver of the heterogeneity.