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Factors like PTEN loss, activation of Wnt/-catenin signaling, and overexpression of proteins such as CBX2 and HE4 are frequently linked to enhancing the M2 phenotype and poorer clinical outcomes

NICE guidelines (NG49) emphasise that weight loss, dietary changes, and increased physical activity are the most effective interventions for improving liver health in NAFLD

Notably, after a 4-week washout period these beneficial effects diminished, with the exception of clinical severity scores

For example, Koliada and colleagues (2017) showed that obese individuals have a significantly higher level of Firmicutes and lower level of Bacteroidetes compared to normal-weight or lean adults

3 Institute of Medical Systems Bioinformatics, Center for Biomedical AI (bAIome), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany