INS and metabolic dysfunction-associated steatohepatitis: Furthermore, a few large multicenter case-control studies demonstrated a role of SNPs implicated in insulin signalling [21], oxidative stress [22], and fibrogenesis [23] in the progression of NAFLD towards NASH confirming that hepatocellular fat accumulation and IR are key operative mechanisms in the pathophysiology of NAFLD and are closely involved in the progression of liver damage.