Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease globally. NAFLD encompasses broader spectrum of liver pathology from fatty liver to non-alcoholic steatohepatitis (NASH) and cirrhosis. Its burden is expected to rise due to the increasing prevalence of obesity and diabetes mellitus worldwide. However, pathogenic mechanisms underlying NAFLD are not clearly understood. Hyperhomocysteinemia is increasingly being associated with NAFLD. Pathogenesis of NAFLD involves dysregulation/derangements of homocysteine, folate, and vitamin B-6 and B-12 metabolism. Obesity is also shown to be associated with these vitamin deficiencies and homocysteine elevation. Recently, Cystathionine-beta-synthase (CBS) and Cystathionine-gamma-lyase (CSE), key enzymes that regulate the levels of homocysteine and cysteine and production of endogenous hydrogen sulfide (H2S), have been implicated in NAFLD. In this review, we have examined known associations between NAFLD, hyperhomocysteinemia and obesity.