It has been demonstrated that the liver protective mechanisms of metformin in non-alcoholic fatty liver disease may be contributed to down-regulation of secretory phospholipase A2 mRNA expression, decrease in serum secretory phospholipase A2, lysophosphatidylcholine and lower inflammatory response in rat model [29] Although animal data in experimental models have demonstrated that this treatment is able to retard the progression of hepatosteatosis, results from human studies have been varied. This evidence concerns the gene PLA2G2D and metabolic dysfunction-associated steatotic liver disease.