While low serum bilirubin levels are also associated with increased HOMA-IR and insulin levels [13], the association between increased direct bilirubin and lower incidence of NAFLD in our study persisted after adjusting for a variety of measures of insulin resistance and after restricting the analysis to participants with no evidence of insulin resistance, suggesting that the protective role of direct bilirubin is independent of insulin resistance. The gene discussed is INS; the disease is metabolic dysfunction-associated steatotic liver disease.