Mixed

Gut microbiota transplantation from high-cholesterol diet-fed mice to germ-free mice is sufficient to induce hepatic lipid accumulation, inflammation, and cell proliferation, demonstrating a causal role for microbiota in NAFLD-HCC.

Your gut bacteria are not just passengers; they can drive liver disease. If your diet has altered your gut bacteria to favor harmful types, those bacteria can directly cause liver inflammation and fat accumulation, even if you change your diet later.