The liver is an essential organ for energy metabolism, and dysfunction of energy metabolism or metabolic syndrome impacts its function, resulting in the progression of NAFLD and NASH. Therefore, strategies modulating the change of metabolic dysfunction can be applied to treat liver diseases. Current treatment options for NAFLD/NASH can be divided into medication and non-medication treatment. Non-medication treatment comprised lifestyle modification (diet and exercise), endoscopic bariatric and metabolic therapies (EBMTs), bariatric surgery and modification of gut microbiota.
　　Diet and exercise remain the key therapeutic elements to fight the burden of NAFLD. However, the adherence to lifestyle interventions declines in parallel with the duration of the intervention. Bariatric surgery can achieve significant weight loss and improvement of NAFLD both biochemically and histologically. EBMTs also appear effective at treating NAFLD, but the follow-up time is usually short. The evidence of modification of gut microbiota on NAFLD is scarce. Moving from association to causation between gut microbiota and NAFLD remains a significant challenge. A huge gap in the development of therapies by targeting specific gut microbiota species or gut microbiota-derived metabolites remains.