Several mechanisms have been explored to explain the hepato-protective effects of TZDs in the treatment of NAFLD, including: amelioration of insulin resistance, increasing adiponectin concentration, reducing the TNF-α production, activation of AMP-related protein kinase and inactivation of the intracellular pro-inflammatory signaling pathway [4-6,29]. Here, TNF is linked to metabolic dysfunction-associated steatotic liver disease.