Although the serum resistin level is almost the same in NAFLD, the ALT and CK-18 are significantly increased in NASH patients compared with simple steatosis which means that it is the resistin in the liver that may initiate the progression from simple steatosis to NASH and it is the resistin in the liver that correlated with inflammation and fibrosis and, damage the liver tissue to release biomarkers of liver injury. This evidence concerns the gene KRT18 and metabolic dysfunction-associated steatohepatitis.