Fig. 2.

Theoretical model for factors contributing to periportal inflammation/fibrosis, which may contribute to NAFLD progression. Multiple perinatal and environmental factors have been linked to the development of periportal disease (inflammation/fibrosis). In relation to NAFLD, periportal disease is more common in children and associated with the development of fibrosis. Studies in mice have shown that maternal obesogenic diet exposure is associated with baseline periportal inflammation/fibrosis in offspring. Although the mechanisms are not defined, vertical transmission of an altered gut microbiome likely plays a role. A developing hypothesis is that predisposition for periportal disease due to these factors contributes to worse disease progression in NAFLD. (Illustration by Astrid Rodriguez‐Velez and Anne Robinson in association with InPrint at Washington University in St. Louis. Reprinted with permission.).