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Decreased activity of the mitochondrial respiratory chain was reported in overweight/obese patients with NASH compared to controls [97, 98], and alterations in mitochondrial ultrastructure have been observed prior to NAFLD development in the Otsuka LongEvans Tokushima Fatty rat [99] as well as in patients with steatosis preceding progression to NASH [100]

Dysfunctional microglia may fail to eliminate pathogens or apoptotic cells and may trigger maladaptive inflammatory responses [135, 136]

Mechanistic insights into L-carnitine's effects on insulin resistance include: Inhibition of NF-B-mediated chronic inflammation: NF-B signaling promotes systemic inflammation and directly interferes with insulin signaling pathways, exacerbating IR (60)

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