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95% CI 11.0 2.0).18 Pathogenesis The liver plays a central role in lipid metabolism, importing serum free fatty acid ester fatty acids and manufacturing, storing and exporting lipids and lipoproteins. However, the pathophysiology that leads to NAFLD is not well understood; in particular, the factors that fatty acid ester lead to progressive hepatocellular damage after triglyceride accumulation are not well elucidated. It appears that alteration of local and systemic factors (particularly insulin resistance) that control the balance between the influx or synthesis of hepatic lipids and their export or oxidation leads to hepatic triglyceride accumulation. The fatty acid ester steatotic liver is then thought to be vulnerable to secondary insults, which lead to hepatocellular inflammation and fibrosis.
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