Metabolism-associated fatty liver disease (MAFLD) is defined as the presence of excess fat in the liver in the absence of excess alcohol consumption and metabolic dysfunction. It has also been described as the hepatic manifestation of metabolic syndrome. The incidence of MAFLD has been reported to be 43-60% in diabetics, ~90% in patients with hyperlipidemia and 91% in morbidly obese patients [1-3]. Risk factors that have been associated with the development of MAFLD include male gender, increasing age, obesity, insulin resistance, diabetes and hyperlipidemia [4, 5]. All of these risk factors have been linked to alterations of the gut microbiota, ie., gut dysbiosis [6]. MAFLD can progress to nonalcoholic steatohepatitis (NASH) with the presence of inflammation and ballooning, which can deteriorate into cirrhosis, MAFLD-related hepatocellular carcinoma (HCC), and liver failure [7, 8]. In this review we will be focused on the role of the gut microbial metabolome in the development, progression and potential treatment of MAFLD.