ANPEP and Insulin resistance: 2010). Moreover, insulin resistance which is associated with reduced systemic APN levels (Lihn et al. 2005) correlates with increased severity of hepatic fibrosis in these patients (Moucari et al. 2008). Accordingly, lower APN serum levels are inversely associated with advanced hepatic fibrosis in nondiabetic (Musso et al. 2005) and type 2 diabetic (Leite et al. 2013) patients with nonalcoholic steatohepatitis.