This is different from the findings in obese individuals when expanding visceral adipose tissue (VAT) stores and NASH promote a chronic low-grade state of inflammation with elevated serum levels of TNF, IL-1, IL-6 and other cytokines in the peripheral blood.30 Although several studies have explored the relationship of physical activity and the immune system in recent years, no data regarding the hepatic phenotype have been available. Here, TNF is linked to metabolic dysfunction-associated steatohepatitis.