Hyperinsulinemia and increased insulin resistance could have important roles in the pathogenesis of NASH in both Western and Asian countries.34, 35, 36, 37 Hyperinsulinemia in patients with NASH is attributable to increased insulin secretion, which compensates for reduced insulin sensitivity and is not a consequence of decreased hepatic extraction of insulin, which occurs in all forms of chronic liver disease at the stage of advanced fibrosis or cirrhosis.34, 35 In this study, fasting insulin and fasting plasma glucose decreased together with adiponectin. Here, INS is linked to metabolic dysfunction-associated steatohepatitis.