Non-alcoholic fatty liver disease (NAFLD) presents a chronic condition that links the overarching influence of the intestinal microbiome to a disease state with the multisystem manifestations of obesity, type 2 diabetes (T2D), chronic kidney disease (CKD) and cardiovascular disease (CVD) (1). NAFLD is an increasingly common disease with a current prevalence of 25％ worldwide (2). The proportion of severe presentations of NAFLD is also increasing and these trends will lead to an increased burden from NAFLD sequelae, including cirrhosis, liver failure and hepatocellular cancer (2).