Why do some people like me with fatty liver develop inflammation (NASH), while some do not? Is it possible to get rid of the inflammation?
There are two types of fatty liver disease, alcoholic and nonalcoholic. Usually, inflammation caused by alcoholic fatty liver disease will go away once the patient ceases alcohol intake. The situation is different for nonalcoholic fatty liver disease (NAFLD). NAFLD is characterized by the accumulation of fat in the liver, it is a spectrum of diseases that ranges from mild to severe. Although having fat in the liver is not normal, simple fatty liver generally does not cause great harm. In addition, many people with fatty liver do not have any symptoms and have normal liver function. 
However, when the buildup of fat in the liver causes inflammation in liver cells, liver health may be threatened. This situation is known as nonalcoholic steatohepatitis (NASH), a more severe form of NAFLD. NASH is characterized by buildup of fat in the liver, along with inflammation and liver damage. The ALT level of NASH patients are usually more elevated than those with fatty liver.
The exact cause of NASH is not yet known. It occurs more frequently in middle-aged and overweight or obese people. The number of female with NASH is also higher than male. Many NASH patients also have certain medical conditions such as diabetes, high blood cholesterol or triglyceride and insulin resistance. But there are also some who do not have diabetes, are not obese and have normal blood lipids.  Thus, at the moment, it cannot be concluded that these are the factors that lead to inflammation in the liver.
Medical professionals generally advise NASH patients to reduce weight (if overweight), control their diet and increase physical exercise to treat NASH. Besides lifestyle changes, research papers on PubMed show that a compound made from natural ingredients, YHK, has positive effects on NASH patients.  It has been proven that YHK has anti-inflammatory effects and can restore normal liver function. A double-blind clinical study of the compound also indicates that the ALT levels of patients lowered to normal level within 2 weeks of using YHK. 
- Kneeman, J. M., Misdraji, J., & Corey, K. E. (2012). Secondary causes of nonalcoholic fatty liver disease. Therapeutic Advances in Gastroenterology, 5(3), 199–207.
- Nonalcoholic Steatohepatitis. (2006). Retrieved from http://www.niddk.nih.gov/health-information/health-topics/liver-disease/nonalcoholic-steatohepatitis/Pages/facts.aspx (accessed 27/8/2015)
- Stefano, J.T., de Oliveira, C.P., Corrêa-Giannella, M.L., de Lima, V.M., de Sá, S.V., de Oliveira, E.P., … Carrilho, F.J. (2007). Nonalcoholic steatohepatitis (NASH) in ob/ob mice treated with yo jyo hen shi ko (YHK): effects on peroxisome proliferator-activated receptors (PPARs) and microsomal triglyceride transfer protein (MTP). Digestive Diseases and Sciences, Dec;52(12):3448-54. PMID: 17394061
- de Lima, V.M., de Oliveira, C.P., Sawada, L.Y., Barbeiro, H.V., de Mello, E.S., Soriano, F.G., … Carrilho, F.J. (2007). Yo jyo hen shi ko, a novel Chinese herbal, prevents nonalcoholic steatohepatitis in ob/ob mice fed a high fat or methionine-choline-deficient diet. Liver International, Mar;27(2):227-34. PMID: 17311618
- Chande, N., Laidlaw, M., Adams, P., Marotta, P. (2006). Yo Jyo Hen Shi Ko (YHK) improves transaminases in nonalcoholic steatohepatitis (NASH): a randomized pilot study. Digestive Diseases and Sciences, Jul;51(7):1183-9. PMID: 16944007
- * All research and clinical data should be used as reference purposes only, results may vary.