Fructose and nonalcoholic fatty liver disease (NAFLD): the multifaceted aspects of fructose metabolism. Excessive fructose consumption is associated with hepatic steatosis, cellular stress and inflammation. This is responsible for the release by the liver of lipids, methyglyoxal, uric acid, and hepatokines leading to alterations in the communication between the liver and the gut, muscles, and adipose tissue and to disease aggravation. LPS, lipopolysaccharides; TNFα, tumor necrosis factor α; IL6, interleukin-6; NEFA, non-esterified fatty acid; ATP, adenosine triphosphate; ADP, adenosine diphosphate; FGF21, fibroblast growth factor 21; AA, amino acids.