This comment discusses the study by Videla and colleagues in this issue of Clinical Science in which they have analysed surgical liver biopsies from obese patients with non-alcoholic fatty liver disease and demonstrate that fatty liver is associated with a state of oxidative stress and a decreased antioxidant activity. As the disease progresses to steatohepatitis, the defect in antioxidant systems increases. Thus efficiency of antioxidant defence mechanisms, by setting the threshold at which pro-oxidants would become injurious, might represent a determining factor for disease progression from stable steatosis to steatohepatitis.

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