A 45-year-old obese male with type 2 diabetes mellitus presents with fatigue and right upper quadrant discomfort. His BMI is 32 kg/m², and liver function tests reveal elevated ALT and AST levels, with ALT > AST (ratio < 2). An abdominal ultrasound shows increased echogenicity of the liver. What is the primary pathophysiological mechanism responsible for the development of NAFLD in this patient?

By usmlevideoss