Nonalcoholic fatty liver disease (NAFLD) is characterized by a broad spectrum of clinical and histological presentations, ranging anywhere from simple steatosis to steatohepatitis. Of the patients with NAFLD, only a small fraction goes on to develop inflammation and fibrosis (i.e. NASH). Hence, understanding the underlying molecular mechanisms, which play part in progression of NAFLD and determine the disease severity, is extremely important. Almost two decades ago, Day and colleagues first described the “two-hit hypothesis” to explain progression of NAFLD. However, since then, the advances in field of molecular research have identified that NAFLD development and progression involves complex interplay of numerous determinants, including gut-derived signals, endoplasmic reticulum stress, adipose-derived adipokines, nutritional factors, hormonal imbalances and components of innate immunity which act in concert on genetically predisposed individuals to induce liver inflammation. This chapter reviews the different players of this “multiple-hit model”.
Part of the book: Non-Alcoholic Fatty Liver Disease