Published online May 15, 2016. doi: 10.4291/wjgp.v7.i2.211
Peer-review started: September 5, 2015
First decision: November 30, 2015
Revised: January 3, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: May 15, 2016
Core tip: Insulin resistance is considered as the major contributor for the development and progression of nonalcoholic fatty liver disease (NAFLD). However, recent evidence that has shown that non-obese individuals from developing countries are also affected by NAFLD, thus the conventional paradigm of NAFLD as the “hepatic manifestation of metabolic syndrome” has become outdated. Recent studies have highlighted novel pathophysiological mechanisms for the development and progression of NAFLD. Insulin resistance contributes to the disease process, but it is evident that environmental and genetic factors also contribute for development of necroinflammation and subsequent progression to fibrosis. This review provides a summary of current knowledge of the pathogenesis of NAFLD and discusses factors that dissociate insulin resistance from NAFLD.