Mechanisms of disease: pathogenesis of nonalcoholic fatty liver disease

Nonalchoholic fatty liver disease (NFALD) is associated with the metabolic syndrome. The metabolic syndrome is characterized by insulin resistance, which is produced by a complex interaction between genetic factors, macronutrient intake and lifestyle that alters the cytokine profile factors, micronutrient intake and lifestyle that alters the cytokine profile, cell biology and biochemical milieu of the liver, adipose tissue and striated muscle. The resultant disequilibrium in lipid homeostasis causes triglycerides to accumulate in the liver. An increase in oxidative stress, due to the generation of reactive oxygen species as a result of mithochondrial abnormalities and induction of the cythochrome P-450 system could be one mechanism by which the nonalcoholic steatohepatitis. The pathogenesis of cyctologic balloning and Mallory body formation and their role in NAFLD remain to be defined. In addition, inflammation and fibrosis are likely to be secondary to hepatocyte injury and death.