Interplay between intestinal permeability and metabolic dysfunction-associated steatotic liver disease: Could there be a role for extra virgin olive oil consumption?

Metabolic dysfunction-associated steatotic liver disease is a multifaceted disease associated with obesity, insulin resistance (IR), type 2 diabetes mellitus - in a word, metabolic syndrome - which has been extensively studied because it is related to an alteration of the normal metabolism of glucose and lipids, ultimately leading to triglyceride accumulation within hepatocytes. This lipid overload triggers an inflammatory status, also influenced by gut-liver axis dysfunction, with gut dysbiosis, which alters intestinal permeability, causing inflammation and IR in a vicious circle. Several approaches have been attempted to treat this condition and stop its possible evolution towards increasingly serious stages, but the first step is always lifestyle modification. The Mediterranean diet seems to be the most reliable for affecting liver steatosis, probably thanks to extra virgin olive oil, a healthy food with a high content of monounsaturated fatty acids and variable concentrations of phenols (oleocanthal) and phenolic alcohols, such as hydroxytyrosol and tyrosol. This review investigates the mechanisms underlying the bidirectional and synergistic relationships among metabolic dysfunction-associated steatotic liver disease, IR, and the gut-liver axis, specifically focusing on the role of extra virgin olive oil as one of the main antioxidant components of the Mediterranean diet.