1 Department of Clinical Medicine and Surgery, "Federico II" University Medical School of Naples, 80131 Naples, Italy.
2 Department of General Medicine, "Umberto I" Hospital, 84014 Nocera Inferiore (Sa), Italy.
3 Care Department of Public Health and Drug-Use, Section of Medical Pharmacology and Toxicology, "Federico II" University, 80131 Naples, Italy.
Focusing on previously published mechanisms of non-alcoholic fatty liver disease (NAFLD), their uncertainty does not always permit a clear elucidation of the grassroot alterations that are at the basis of the wide-spread illness, and thus curing it is still a challenge. There is somehow exceptional progress, but many controversies persist in NAFLD research and clinical investigation. It is likely that hidden mechanisms will be brought to light in the near future. Hereby, the authors present, with some criticism, classical mechanisms that stand at the basis of NAFLD, and consider contextually different emerging processes. Without ascertaining these complex interactions, investigators have a long way left ahead before finding an effective therapy for NAFLD beyond diet and exercise.