In Shashaj et al. study [22] mean fasting insulin concentration in obese patients was 13.8 μIU/ml ± 9.4, while in Pacifico et al. it was 10.6 μIU/ml in obese children without steatosis and 15.6 μIU/ml in obese children with NAFLD [36]. This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.