ABSTRACT
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver dysfunction and has complex pathogenesis and progression. With in-depth studies in recent years, the theory of “two hits” has gradually been replaced by the theory of “multiple hits”. The theory of “multiple hits” including the neuroendocrine immune inflammatory network suggests that various factors participate in the progression of NAFLD, such as insulin resistance, adipose tissue dysfunction, mitochondrial dysfunction, endoplasmic reticulum stress, inflammatory activation, fatty acids, gut microbiota, iron overload, dietary factors, genetic factors, and epigenetic factors. With reference to the research advances in recent years, this article reviews the pathogenesis of NAFLD from the aspects of genetic and epigenetic factors, gut microbiota, intrahepatic immune cells, and aquaporin.