How does insulin resistance relate to NASH?
Almost all patients with NASH are insulin resistant to some degree. However, only a minority of patients who are insulin resistant develop NASH. While an increased amount of fat in the liver may in itself lead to inflammation (see below), no evidence suggests that insulin resistance alone can lead to NASH. What else besides insulin resistance contributes to NASH? The process whereby liver inflammation and death of liver tissue develop in NASH remains to be clearly explained. Several theories, however, have been advanced. First, it is possible that the accumulation of fat in the liver alone could lead to the development of NASH. According to this theory, the large quantity of fat in the liver is thought to be a source of peroxidation (removal of electrons from molecules). Peroxidation thereby generates so-called free radicals. These free radicals then damage proteins and organelles (small structures within a cell) in the liver cells. Finally, this damage leads to cell death and/or an in
