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Page 10 of 17 Nasr et al. Metab Target Organ Damage 2023;3:19 https://dx.doi.org/10.20517/mtod.2023.20

Figure 1. A schematic illustration of the included steatogenic causes of hepatic lipid accumulation. Often, several concomitant causes of
steatotic liver disease exist where separating the two is difficult. Although some causes only seem to increase hepatic fat infiltration in
the presence of insulin resistance (A) some can elicit steatogenic properties by themselves (i.e., in the absence of insulin resistance)
(B) or by inducing insulin resistance (C).

most severe cases .
[178]

SUMMARY
Most cases of SLD are associated with cardiometabolic risk factors, most commonly insulin resistance. The
absence of signs and symptoms of the metabolic syndrome on clinical work-up warrants assessment of
secondary causes of SLD. Many of these causes can be considered co-factors that aggravate primary
MASLD, but some can trigger hepatic lipid accumulation per se [Figure 1]. Drug treatment and other
primary liver diseases need to be evaluated and congenital metabolic defects should be considered,
especially in younger people.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study: Nasr P, Jönsson C, Ekstedt M,
Kechagias S

Availability of data and materials
Not applicable.

Financial support and sponsorship
ALF Grants, Region Östergötland and Wallenberg Centre for Molecular Medicine (WCMM), Linköping
University.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.