In morbidly obese patients, circulating pro-NT levels were also reported to be positively correlated with the presence and severity of NAFLD, as evaluated by the NAFLD activity score and histological evidence of visceral adipose tissue inflammation that leads to systemic low-grade inflammation, increased circulating fatty acid concentrations, insulin resistance and aberrant fat deposition in the liver [131]. This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.