**7.9 With or without 'lipolysis and lipotoxicity'**

In discussing the prognosis of liver steatosis, NAFLD does not necessarily lead to NASH because NAFLD is an extremely heterogeneous condition. This heterogeneity exists in part because different types of lipids with different cytotoxic potentials accumulate in the NAFLD, and individuals with NAFLD differ in their ability to defend against lipotoxicity. Differences in these wound-healing responses among individuals determine whether the lipotoxic livers regenerate, leading to stabilisation or resolution of NASH, or develop progressive scarring, cirrhosis and possibly liver cancer.

The perception that the lipotoxic potential of various types of lipids differs can help explain why the outcomes of hepatic steatosis vary as a matter of fact. Interventions that block the accumulation of lipotoxic lipids might, therefore, be used to prevent or treat NASH. Multiplying of fatty acids within the mitochondria could also dissipate the protonmotive force that typically occurs during mitochondrial respiration [148]. This makes mitochondria more vulnerable to other insults that collapse the mitochondrial membrane potential, such as tumour necrosis factor alpha
