In patients with NAFLD, the impact of exercise training on bile acids and the FXR pathway remains largely unexplored, although a small pilot study demonstrated that aerobic exercise training reversed the dysbiosis that is the hallmark of NAFLD and NASH, which could potentially change the levels of secondary bile acids and affect the bile acid pool indirectly [136]. Here, NR1H4 is linked to metabolic dysfunction-associated steatotic liver disease.