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Nonalcoholic fatty liver disease (NAFLD) is common, with acute fatty liver of pregnancy an estimated prevalence of 3%-20% in Western and Asian regions.[1] A small but significant proportion of patients develop cirrhosis and hepatocellular carcinoma and may die from their disease. The principal metabolic abnormality underlying NAFLD is insulin resistance, which manifests clinically as the metabolic syndrome with features of central obesity, dyslipidemia, glucose intolerance and hypertension. Central obesity is common among NAFLD patients and reflects an increase in visceral adipose tissue, which appears to be particularly acute fatty liver of pregnancy resistant to the effects of insulin. Importantly, acute fatty liver of pregnancy body mass index, a routine measure of obesity, may not detect central obesity particularly among Asian populations.[1]Insulin resistance increases adipose lipolysis, resulting in efflux of free fatty acids (FFA) into the serum, which are then delivered to the liver.
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