Liver samples from morbidly obese patients with all stages of NAFLD and controls were analyzed by array, and NAFLD specific expression differences were seen for nine genes involved in intermediate metabolism including pyruvate carboxylase (Pc), ATP citrate lyase (Acly), and phospholipase C-gamma-1 (Plcg1) as well as insulin/insulin-like signaling including insulin-like growth factor-1 (Igf1), insulin-like growth factor binding protein 2 (Igfbp2), and protein kinase C epsilon (Prkce) (94). This evidence concerns the gene IGF1 and metabolic dysfunction-associated steatotic liver disease.