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Accurate epidemiological information is hard to acquire as NASH is essentially a histological diagnosis rapid weight loss and therefore requires biopsy. However, calculations suggest that in the USA it affects about 3% of lean individuals, about 19% of the obese and about 50% of the morbidly rapid weight loss obese or those with diabetes mellitus. It may occur in about 2% of children, but in 20-50% of obese children. The pathogenesis of NASH is poorly understood but is probably multifactorial. Insulin resistance has emerged as a condition common to all forms of NASH and it is probably primarily important in producing steatosis as it is found in NAFL as well as in NASH. However, other factors including insulin resistance are also required for progression to hepatitis and such factors include oxidative stress damaging membrane lipids and possibly leptin.
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