Hormonal
In nonalcoholic steatohepatitis (NASH), the accumulation of triglyceride in lipid droplets is an innocent bystander and protective mechanism, whereas lipotoxicity is caused by nontriglyceride fatty acid metabolites (such as ceramides, diacylglycerols, and lysophosphatidylcholine) that induce cellular injury, inflammation, and apoptosis.
Focus on reducing the flow of fatty acids into the liver rather than just trying to 'detox' stored fat. This is achieved by improving insulin sensitivity (reducing inappropriate lipolysis from fat tissue) and limiting carbohydrate intake (reducing de novo lipogenesis). The presence of liver fat (steatosis) is not the primary enemy; the toxic metabolites generated from unmanaged fatty acid flux are.
emerging data now suggests that in the liver, as in other organs, triglyceride accumulation in the form of lipid droplets truly is just an 'innocent bystander' in the processes leading to cellular injury and inflammation... emerging evidence now points to metabolites of fatty acids as the real culprits in the hepatocellular injury in NASH
Why this rating
The paper is a review citing multiple animal models and human biopsy studies, but acknowledges that definitive proof in humans is still emerging and some data is conflicting.
Source
Hepatic lipotoxicity and the pathogenesis of nonalcoholic steatohepatitis
Brent A. Neuschwander‐Tetri · Hepatology · 2010
DOI 10.1002/hep.23719
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