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Some research has examined the relative merits of pulsatile GH release (as produced by injectable GHS peptides) versus continuous GH elevation, with pulsatile patterns generally considered more physiologically favorable for maintaining receptor sensitivity

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Several mechanisms including glucotoxicity, lipotoxicity, altered secretion of adipokines/cytokines, hepatokines (mainly higher circulating fetuin-A levels), stimulation of multiple inflammatory pathways, reduced bile-acid synthesis, endoplasmic reticulum stress, increased oxidative stress, mitochondrial dysfunction and alterations in gut microbiota/gut-derived endotoxins, in a complex interplay with genetic predisposition, drive the evolution of inflammation, hepatocellular injury and fibrosis [2426]