AKT1 and hyperinsulinism: High lipid levels can also affect autophagy activity.7 Hyperinsulinemia may contribute to downregulation of autophagy through the Akt/protein kinase B (PKB) pathway in fatty liver.8 In addition, autophagy is suppressed in steatotic livers by mammalian target of rapamycin (mTOR) overactivation as a result of an increased amino-acid concentration following overnutrition.9 Therefore, a harmful cycle may exist in which independent factors promote both reduced autophagy and hepatic steatosis, and that the decrease in autophagy exacerbates steatosis, further impairing autophagy.