Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major contributor to liver-related morbidity, cardiovascular disease, and metabolic complications. Lifestyle interventions, including diet and exercise, are first line in treating MASLD. Dietary approaches such as the low-glycemic-index Mediterranean diet, the ketogenic diet, intermittent fasting, and high fiber diets have demonstrated potential in addressing the metabolic dysfunction underlying this condition. The development and progression of MASLD are closely associated with taxonomic shifts in gut microbial communities, a relationship well-documented in the literature. Given the importance of diet as a primary treatment for MASLD, it is important to understand how gut microbiota and their metabolic byproducts mediate favorable outcomes induced by healthy dietary patterns. Conversely, microbiota changes conferred by unhealthy dietary patterns such as the Western diet may induce dysbiosis and influence steatotic liver disease through promoting hepatic inflammation, up-regulating lipogenesis, dysregulating bile acid metabolism, increasing insulin resistance, and causing oxidative damage in hepatocytes. Although emerging evidence has identified links between diet, microbiota, and development of MASLD, significant gaps remain in understanding specific microbial roles, metabolite pathways, host interactions, and causal relationships. Therefore, this review aims to provide mechanistic insights into the role of microbiota-mediated processes through the analysis of both healthy and unhealthy dietary patterns and their contribution to MASLD pathophysiology. By better elucidating the interplay between dietary nutrients, microbiota-mediated processes, and the onset and progression of steatotic liver disease, this work aims to identify new opportunities for targeted dietary interventions to treat MASLD efficiently.

Long COVID, also referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent multi-systemic symptoms such as fatigue, cognitive impairment, and respiratory dysfunction. Accumulating evidence indicates that gut and oral microbiota play an important role in its pathogenesis. Patients with long COVID consistently exhibit reduced microbial diversity, depletion of beneficial short-chain fatty acid (SCFA)-producing species such as Faecalibacterium prausnitzii and Bifidobacterium spp. and enrichment of proinflammatory taxa including Ruminococcus gnavus, Bacteroides vulgatus, and Veillonella. These alterations may disrupt intestinal barrier integrity, sustain low-grade systemic inflammation, and influence host immune and neuroendocrine pathways through the gut–brain and gut–lung axes. Distinct microbial signatures have also been associated with symptom clusters, including neuropsychiatric, respiratory, and gastrointestinal manifestations. Proposed mechanisms linking dysbiosis to long COVID include impaired SCFA metabolism, tryptophan depletion, microbial translocation, and interactions with host immune and inflammatory responses, including autoantibody formation and viral antigen persistence. Preliminary interventional studies using probiotics, synbiotics, and fecal microbiota transplantation suggest that microbiome-targeted therapies may alleviate symptoms, although evidence remains limited and heterogeneous. This review synthesizes current literature on the role of gut and oral microbiota in long COVID, highlights emerging microbial biomarkers, and discusses therapeutic implications. While causality remains to be firmly established, restoring microbial balance represents a promising avenue for diagnosis, prevention, and management of long COVID.

Background: Intragastric balloon (IGB) therapy is a minimally invasive endoscopic intervention primarily utilized for weight reduction in patients with Class I and II obesity. While less frequently utilized in individuals with Class III obesity (BMI ≥ 40 kg/m²), IGB placement may be considered as a bridge to bariatric surgery or when surgery is contraindicated or declined. However, data regarding short-term safety outcomes in this higher-risk population remain limited. Objective: This study aims to compare 30-day safety outcomes after IGB placement in patients with BMI ≥ 40 kg/m² versus BMI < 40 kg/m². Methods: This was a retrospective cohort study of 4,555 patients undergoing primary IGB placement from 2016 to 2023 using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Primary outcomes included hospital length of stay and 30-day rates of outpatient intravenous (IV) treatments, emergency department (ED) visits, readmissions, reoperations, interventions, and mortality. Patients were stratified by BMI ≥ 40 kg/m² and BMI < 40 kg/m² for comparative analysis using propensity score-matching (PSM). 962 pairs were identified for PSM. Results: Patients with BMI ≥ 40 kg/m² were younger on average and more likely to be male and non-Hispanic Black. This group exhibited a higher prevalence of associated medical problems, including diabetes, obstructive sleep apnea, hypertension, renal insufficiency, immunosuppressant use, thromboembolic events, and therapeutic anticoagulation use. After adjustment for baseline differences, patients with BMI ≥ 40 kg/m² were more likely to require a postoperative hospital length of stay longer than one day ( p = 0.003). No significant differences in 30-day outpatient IV treatments, ED visits, readmissions, reoperations, interventions, or mortality, were observed. Conclusion: Patients with BMI ≥ 40 kg/m² exhibited a greater burden of associated medical problems and longer hospital length of stay, but otherwise demonstrated comparable short-term safety outcomes to those with BMI < 40 kg/m². These findings suggest comparable 30-day hospital-based safety outcomes after IGB placement in patients with BMI ≥ 40 kg/m² compared with BMI < 40 kg/m².

Background: Intragastric balloon (IGB) therapy is a minimally invasive endoscopic intervention for weight reduction in patients with Class I-II obesity and in lower BMI patients with obesity-related comorbidities such as diabetes mellitus. Diabetes mellitus is associated with vascular complications, increased susceptibility to infection and delayed gastric emptying, underscoring the need to evaluate procedural safety and device tolerance in this population. However, evidence regarding short-term safety in this higher-risk population remains limited. This study aims to compare 30-day safety outcomes after IGB placement in patients with and without diabetes mellitus. Methods: This was a retrospective cohort study of 4,555 patients undergoing primary IGB placement using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2015 to 2023. Propensity score-matching was performed in R version 4.5.0 to balance baseline characteristics in two matched analyses: (1) patients with diabetes mellitus matched to patients without diabetes mellitus, and (2) non-insulin dependent diabetes mellitus (NIDDM) versus insulin-dependent diabetes mellitus (IDDM). Outcomes included 30-day rates of outpatient intravenous (IV) treatments, emergency department (ED) visits, hospital readmissions, reoperations, procedural interventions, and serious adverse events (SAEs). Results: Patients with diabetes, particularly those with insulin dependence, were older, more frequently male, and had a higher burden of cardiometabolic-associated medical problems compared to patients without diabetes. Among 424 propensity-matched patients with and without diabetes, rates of 30-day healthcare utilization including outpatient IV treatment, ED visit, hospital readmission, reoperation, and procedural intervention were comparable. Postoperative SAEs were rare, with no observed significant differences in rates of organ space infection, pneumonia, unplanned intubation, pulmonary embolism, deep vein thrombosis, prolonged mechanical ventilation, urinary tract infection, renal insufficiency, acute renal failure, cerebrovascular accident, cardiac arrest, myocardial infarction, sepsis, septic shock, unplanned intensive care unit admission and mortality. In a sub-analysis of 106 matched patients with NIDDM and IDDM, 30-day healthcare utilization and all postoperative SAEs were likewise similar, with no observed statistically significant differences between cohorts. Conclusion: Patients with diabetes exhibited a greater burden of associated medical problems but demonstrated comparable rates of short-term healthcare utilization, safety outcomes and tolerability to those without diabetes after adjustment for baseline differences. These findings support the safety of IGB placement in patients with diabetes and suggest it may be considered both as a safe option for primary weight loss intervention or as a bridge therapy to Metabolic and Bariatric Surgery (MBS) in this population.