Figure 1.

Environmental factors, life style and genetic susceptibility have shown to be implicated in the pathogenesis of visceral obesity and insulin resistance. The metabolic and respiratory complications associated with obesity and insulin resistance as dyslipidemia, OSA (obstructive sleep apnea) Hyperuricemia, hormonal imbalance and systemic low-grade inflammation are established factors in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and progression towards non-alcoholic steatohepatitis (NASH). Remarkably, genetic variation in the patatin-like phospholipase domain-containing protein-3 (PNPLA3) gene is considered a prominent risk factor for progression of liver injury from steatosis to steatohepatitis, cirrhosis and hepatocellular carcinoma (HCC).