The observed changes in zonulin are also consistent with data from a systematic review and meta-analysis showing that intestinal permeability markers reduce in a dose–response manner in people with obesity in response to weight loss.17 The amount of liver fat resolved to normal levels in 71% of the participants, and the reduction in zonulin exhibited a dose–response relationship with the reduction in liver fat. Here, HP is linked to obesity due to melanocortin 4 receptor deficiency.