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Additional information Authors' contributions EMC executed the experiments and wrote the manuscript

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Some factors believed to lead to hepatocyte injury and inflammation include 3,10,12 : Worsening insulin resistance Imbalanced production of certain endogenous ceramides (while ceramides are important for skin integrity, in other tissues they can disrupt fat metabolism and their accumulation in the liver contributes to hepatocyte damage) (Note that supplemental, plant-derived ceramides, sometimes used to support skin health, differ from endogenous ceramides) Increased levels of oxidized lipids and oxidative stress in hepatocytes Gut microbiome disturbance and disrupted intestinal barrier function Mitochondrial dysfunction Inflammatory immune cell activation Emerging preclinical research also shows degeneration of nerves in the liver occurs in the early stages of NAFLD and becomes more pronounced as the condition progresses

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