Figure 1.

Figure. NASH develops in the setting of excess fat being transported to the liver or being produced in the liver, in conjunction with limitations on the capacity of the liver to oxidize fat or return it to the circulation as very low density lipoprotein (VLDL). Dietary factors such as fructose and glucose consumption contribute to this process. The role of genetics, epigenetic changes, and other modifying factors, such as the gut microbiome, are currently being explored in research studies. Multiple treatment options that target differents steps of these pathways are undergoing evaluation in clinical trials. Reducing caloric intake, especially from carbohydrates, and increasing disposal through regular aerobic exercise remain the primary treatment recommendations.