Response Letter: Steatotic Liver Disease in Younger Adults Is Associated With Altered Gut Microbiology

Dear Editor,
We thank Guan, Zhu and Wang for their interest in our study. They raise several important points, which we address here in turn.

The first comment concerns the number of study participants meeting the criteria for severe steatotic liver disease (SLD). We agree that a larger sample size would enhance statistical robustness, and we fully support the field's efforts to establish larger cohorts. In contrast to the majority of previous studies of SLD, which have drawn participants from clinical cohorts from referral centres, our study was based on a cross-section of 588 young adults from the Raine Study, a prospective community-based cohort study in Western Australia. As such, the proportion of participants with SLD was considerably lower than would be expected in a cohort defined by SLD clinical presentations or elevated risk markers. However, our approach allowed us to investigate poorly understood microbiome–steatosis relationships early in SLD pathogenesis...