“…However, because of continued alcohol intake, other factors become operative, which lead to continued accumulation of triacylglycerol and hence steatosis. In this second phase, there are increases in phosphatidate phosphohydrolase and diacylglycerol acyltransferase activities [15,16], increased fatty acid binding protein levels [19], decreased VLDL secretion [8] and decreased b-oxidation resulting from mitochondrial alterations [33,35,36,38]. In addition, heterozygotes for genetic conditions that would lead to steatosis, such as trifunctional protein deficiency in which heterozygote effects have been observed [43,44], could be predisposed to the development of alcoholic fatty liver.…”