This is the histologic appearance of hepatic macrovesicular steatosis (fatty change). The lipid accumulates in the hepatocytes as vacuoles. These vacuoles have a clear appearance with H&E staining. The most common cause of fatty change in developed nations is termed non-alcoholic fatty liver (NAFL) disease (diabetes mellitus, obesity, metabolic syndrome). Poor socioeconomic status contributes to kwashiorkor in children. Diseases causing severe gastrointestinal malabsorption are additional causes.

Polymorphisms in the patatin-like phospholipase domain containing 3 (PNPLA3) gene encoding for a triacylglycerol lipase involved in lipid regulation may explain greater propensity to develop steatosis in some populations.