Ketones and fatty acids also induce CYP2E1 (90). Findings from rodent studies show that diet-induced obesity leads to increased microsomal ethanol oxidation (115), and clinical research suggests that obesity is associated with a higher alcohol elimination rate (116) and increased CYP2E1-mediated clearance of acetaminophen (117). As shown in Figure 3, CYP2E1 not only metabolizes ethanol to acetaldehyde but also generates reactive oxygen species and hydroxyethyl radicals, which contribute to oxidative stress and potential liver damage (90). These effects can be particularly harmful as they may synergistically promote the development of steatohepatitis when heavy drinking is combined with a high-fat diet (118).
