Further, it may be possible that compromised CRTC1 activity or elevated miR-34a expression in the liver under some metabolically compromised conditions may initiate a vicious cycle that amplifies pathogenic miR-34a while reducing protective CRTC1, and also probably SIRT1, and thereby facilitates the development and progression of NAFLD. Here, SIRT1 is linked to metabolic dysfunction-associated steatotic liver disease.