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Figure 3. Genetic, Epigenetic, and Microbiome Modifiers of MASLD: Sex-Linked Pathways and Gut-Liver Interactions. This figure integrates genetic, epigenetic, and microbiome-related mechanisms contributing to MASLD pathogenesis, emphasizing sex-specific influences. Left side of the figure (Genetic Modifiers in MASLD): ↑Indicates an increase or higher level of a variable; ↓indicates a decrease or lower level of a variable; →indicates a relationship or influence between variables (e.g., “leads to”, “is associated with”, or “results in”). Right side of the figure (Gut-Liver Axis in MASLD): ↓Indicates a relationship or influence between variables (e.g., “leads to,” “is associated with,” or “results in”); ↕ indicates a bidirectional relationship or influence between variables. MASLD: Metabolic dysfunction-associated steatotic liver disease; PNPLA3: patatin-like phospholipase domain-containing protein 3; HSD17B13: hydroxysteroid 17-beta dehydrogenase 13; Erα: estrogen receptor alpha; XX/XY: chromosomal sex complement; LPS: lipopolysaccharide; TLRs: Toll-like receptors.