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The marked fall in IHTG is also likely to underrepresent a considerable fall in intrahepatocellular diacylglycerol content, a key mediator of hepatic insulin resistance , under conditions of reduced net re-esterification. Insulin is a key regulator of TG metabolism in the liver and in adipose tissue, as it inhibits the hydrolysis of existing TGs and stimulates the synthesis of new TGs . While the antisteatotic effect of KD is well-established, the underlying mechanisms by which it does so remain unclear. KD increases plasma NEFA concentrations, the main substrate of IHTG .
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