Other hepatic changes in CD that may be associated with increased intestinal permeability could result in translocation of gut bacteria, kupffer cell stimulation, and production of tumor necrosis factor-α (TNF-α), proinflammatory cytokine, and reactive oxygen species, resulting in nonalcoholic steatohepatitis (NASH). This evidence concerns the gene TNF and metabolic dysfunction-associated steatohepatitis.